b 
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NERVOUS  STATES 
THEIR    NATURE   AND    CAUSES 


Nervous  States 

THEIR  NATURE  AND  CAUSES 


DR.  PAUL  DUBOIS 

Professor  of  Neuropathology  at  the  University  of  Berne  ;  Author  of 

"TAe  Psychic   Treatment  of  Nervous  Disorders";  "TAe 

Influence  of  the  Mind  on  the  Body  "  ;  "  Self-Control 

and  How  to  Secure  Jt  "  ;  Etc. 


AUTHORIZED  TRANSLATION 


By 

EDWARD   G.   RICHARDS 


FUNK  &  WAGNALLS  COMPANY 

NEW  YORK 

1910 


SANTA    BARBARA.    CALIF 


X. 


CONTENTS 

Chapter  Page 

I.  THE  NEW  NAME  FOR  AN  OLD  DIS- 
EASE  7 

II.  PSYCHONEUROSES 22 

III.  OVERWORK  AND  FATIGUE  AS  CAUSES    32 

IV.  EDUCATION  OF  THE  MIND  NECES- 

SARY   48 

V.  THE    LINK    BETWEEN    MIND   AND 

BODY       .    - 63 

VI.  THE  MIND  THE  BEST  WEAPON  IN 

THE  COMBAT 76 

VII.  CONSTANT     AUTOSUGGESTIONS     AS 

CAUSES  AND  REMEDIES      ...     95 


[5] 


Nervous  States,  Their  Nature 
and  Causes1 


THE  NEW  NAME  FOR  AN  OLD 
DISEASE 

NEURASTHENIA  is  not  a  new 
disease  entirely  created  by  the 
conditions  of  modern  life.  The  Neu- 
rasthenic States  have  always  existed; 
they  have  Deen  observed  and  described 
since  the  time  of  Hippocrates  and 
Galen.  Moreover,  they  must  have  been 
frequent,  since  Plato  excluded  from  his 
Republic  "those  men,  always  occupied 
in  dreaming  of  imaginary  sufferings, 
having  lost  all  aptitude  for  the  arts  and 
the  sciences,  incapable  of  understand- 

1  Communication  presented  at  the  Tenth   French 
Congress  of  Medicine,  Geneva,  September,  1908. 

[7] 


NERVOUS    STATES 

ing  and  meditating."  It  is  certainly 
not  the  insane  hypochondriac,  the 
actual  alien,  that  these  words  describe; 
it  is  just  our  "neurasthenic"  keeping 
his  place  in  the  world  while  at  the  same 
time  being  more  or  less  incapable  of 
fulfilling  his  task.  Observe  how  well 
Plato  saw  the  "hypochondriac"  nature 
of  the  preoccupations  of  these  subjects, 
and  the  "psychasthenia"  which  prevents 
them  from  understanding  and  medi- 
tating, which  creates  their  inability  to 
adapt  themselves  to  life. 

If  the  new  drawer,  opened  and  la- 
beled "neurasthenia"  by  the  American 
neurologist,  Beard,  has  been  filled  so 
quickly  and  overflows,  it  is  because  at 
first  the  badly-classed  contents  of  many 
pigeon-holes  have  been  put  into  it,  and 
also  that,  like  children  urged  to  keep 
order,  we  have  crammed  into  it  every- 
thing that  we  did  not  understand. 

Beard  gave  this  name  "neurasthenia," 
[8] 


THEIR    NATURE   AND   CAUSES 

which  has  been  so  successful,  to  a  col- 
lection of  well-known  symptoms,  but 
whose  description  has  to  be  sought  for 
in  numerous  publications  upon  hypo- 
chondria, melancholia,  hysteria,  and  in 
treatises  upon  mental  alienation. 

By  studying  the  bibliography  of  the 
authors  who  have  endeavored  to  sum- 
marize the  question,  I  find  indicated, 
in  about  70  per  cent,  of  cases,  publica- 
tions concerning  hypochondriac  affec- 
tions; in  about  12  per  cent.,  those  which 
treat  of  hysteria,  and  more  rarely  of 
melancholia.  In  other  works  one  ob- 
serves the  terms  vaporous  affections, 
nervous  troubles,  etc.  Very  soon  one 
sees  the  appellation  nervous  weakness 
appear,  the  synonym  of  neurasthenia; 
the  original  expression,  "supplicium 
neuricum"  (G.  Cheyne,  1723-1730), 
indicates  in  a  picturesque  manner  all 
these  species  of  nervous  and  psychic 
affections,  and  the  author  designates 
[9] 


NERVOUS    STATES 

his  "morbid  entity"  by  the  name  "Eng- 
lish malady,"  as  Beard  later  called  it 
"American  nervousness." 

After  about  the  year  1860  the  word 
hypochondria  disappears  little  by  little 
from  the  literature;  it  is  replaced  by 
that  of  "nervous  state,"  and  already  in 
many  writings  one  sees  the  idea  of 
"moral  treatment"  formulated. 

Altho  the  physicians  of  the  eight- 
eenth century  and  the  commencement 
of  the  nineteenth — more  of  psycholo- 
gists and  philosophers  than  we,  in  spite 
of  the  sharp  wind  of  materialism  which 
blew  at  that  epoch — were  able  to  recog- 
nize the  influence  of  mental  representa- 
tions and  the  emotions,  in  our  day 
somatogenic  conceptions  are  returned 
to.  The  clinic  endeavors  to  become 
more  precise;  it  relies  upon  the  con- 
quests of  anatomy  and  of  pathological 
physiology,  and  so  they  speak  of  anemia, 
of  nervous  and  chloro-anemic  affec- 

[10] 


THEIR    NATURE   AND   CAUSES 

tions.  Finally,  localized  neuroses  are 
invented,  limited  to  one  organ: — neu- 
rosis of  the  heart,  of  the  stomach,  of 
the  intestine,  of  the  larynx,  of  the 
genital  organs,  etc.  The  attempt  is 
made  to  characterize  in  one  word  this 
polymorphic  affection  under  the  names 
irritable  weakness,  general  neuralgia, 
spinal  irritation,  cerebro-cardiac  neu- 
ropathy, etc. 

Since  1877,  some  years  after  Beard's 
publication,  Moebius  adopted  the  term 
"neurasthenia,"  and  consecrated  it  by 
the  authority  of  his  name.  The  appella- 
tion passed  finally  into  the  classical 
works  of  all  countries,  and  to-day  the 
word  is  in  every  mouth. 

What  was  the  merit  of  Beard  ?  Was 
it  to  have  created  a  new  word,  to  have 
thus  circumscribed  a  morbid  entity  un- 
known before  him?  No.  He  had  that 
characteristic  peculiar  to  the  Anglo- 
Saxons  of  not  attaching  himself  too 

[11] 


NERVOUS    STATES 

servilely  to  his  predecessors,  of  ob- 
serving for  himself  among  his  patients, 
and  of  describing  simply  the  clinical 
pictures  that  defiled  before  his  eyes. 
It  is  that  independence  which  has  given 
a  particular  mark  to  his  work.  He  thus 
attracted  the  attention  of  observers  to 
these  little-known  affections,  and  if  the 
word  neurasthenia  has  become  dan- 
gerously common,  it  has  had  the  ad- 
vantage of  provoking  new  studies  and 
discussions  which  are  always  useful, 
even  when  sometimes  a  little  confused. 
In  such  complex  questions  one  must 
resign  oneself  to  passing  through  a 
period  of  disorder  in  order  to  come  to 
clear  ideas.  It  makes  us  think;  and  of 
that,  in  my  opinion,  we  have  good  need. 
But  if  we  owe  a  just  tribute  of  hom- 
age to  the  American  author,  we  can 
not  swear  by  the  words  of  the  master 
and  straight  away  adopt  his  views.  It 
is  for  us  to  pursue  the  analysis,  to  bring 

[12] 


THEIR   NATURE   AND   CAUSES 

the  question  always  more  to  the  point; 
it  is  sufficiently  difficult  to  demand  the 
work  of  several  generations.  It  is 
therefore  necessary  to  criticize  the  work 
of  Beard,  to  make  precise  the  clinical 
picture  which  he  sketched. 

First  of  all,  I  regret  that  he  has 
described  the  symptoms  of  the  trouble 
commencing  at  the  crown  of  the  head 
and  ending  at  the  feet,  so  that  one 
learns  to  know  the  sensibility  of  the 
scalp,  the  pupillary  changes,  the  varia- 
tions of  the  expression  of  the  eyes,  the 
congestion  of  the  conjunctiva,  etc.,  be- 
fore the  capital  stigmata  of  the  feeling 
of  exhaustion,  the  depression,  the  pusil- 
lanimity, and  the  want  of  self-mastery. 

He  would  have  done  well  to  put 
in  the  front  rank  these  great  neur- 
asthenic symptoms,  and  to  have  rele- 
gated to  the  second  grade  the  multiple 
physiological  symptoms  which  one  ob- 
serves in  the  nervous  states.  It  would 
[13] 


NERVOUS    STATES 

have  been  necessary  to  seek  carefully 
the  origin  of  these  symptoms,  to  indi- 
cate those  which  were  caused  by  an 
emotional  state,  conscious  or  subcon- 
scious, those  which  arise  through  the 
mental  representations,  by  the  imagina- 
tion, and  those  which  are  the  result  of 
fatigue,  physical,  intellectual,  and  emo- 
tional. Such  an  arrangement  would 
have  rendered  the  work  more  interest- 
ing to  read,  and  would  have  enabled  us 
better  to  grasp  the  nature  of  this  affec- 
tion, so  frequent,  not  only  in  America, 
but  everywhere,  and  as  much  in  the 
country  as  in  the  towns. 

The  term  "neurasthenia"  which  he 
proposed  has  the  advantage  of  being 
short  and  convenient,  and  of  expressing 
the  asthenic  characteristic.  It  has  made 
its  tour  of  the  world,  and  will  remain 
in  our  nomenclature  just  as  that  of 
"hysteria,"  against  which  objections 
still  more  justifiable  have  been  raised 

[14] 


THEIR   NATURE   AND   CAUSES 

without    a    more    suitable    appellation 
being  able  to  be  substituted  for  it. 

But  I  must  point  out  two  drawbacks 
to  the  word  neurasthenia;  it  makes  the 
supposition  that  it  is  the  nerves  that  are 
not  equal  to  their  task,  as  if  it  were  a 
matter  simply  of  a  physico-chemical 
alteration,  as  yet  unknown,  of  the  nerv- 
ous elements.  This  conception  has 
taken  possession  of  the  minds  of  med- 
ical men;  it  is  current  among  the  pub- 
lic, and  it  has  caused  the  psychological 
influences  to  be  forgotten — the  con- 
siderable part  which  the  mind  plays  in 
the  genesis  of  these  states.  I  have 
dealt  at  length  with  these  considera- 
tions in  all  my  publications;  it  is  this 
that  has  made  me  say,  without  wish- 
ing to  propose  a  change  of  nomen- 
clature, that  neurasthenia  is  in  fact  a 
psychasthenia;  it  is  also  the  reason  that 
I  have  replaced  the  term  neuroses  by 
that  of  psychoneuroses. 
[15] 


NERVOUS    STATES 

Used  as  a  substantive,  in  the  singu- 
lar, the  word  "neurasthenia"  encour- 
ages the  idea  of  a  "morbid  entity,"  of 
a  very  limited  affection  which  it  is  easy 
to  separate  distinctly  from  other  more 
grave  psychoneuroses. 

It  is  against  this  tendency  that  I 
would  first  of  all  protest.  No  doubt  the 
clinician  has  the  very  natural  desire  to 
classify  the  affections  which  he  ob- 
serves, to  define  the  symptoms  which 
strictly  belong  to  them,  and,  even  when 
they  do  not  succeed,  these  attempts  con- 
tribute to  the  widening  and  the  deepen- 
ing of  our  knowledge. 

In  the  domain  of  the  organic  dis- 
eases, pathological  anatomy,  chemistry, 
and  microbiology  bring  us  new  facts. 
Analysis  defines  more  and  more  the 
morbid  entity;  it  allows  a  positive  sep- 
aration to  be  established  between  neigh- 
boring and  often  confounded  affections. 
Future  studies  may  further  modify 
[16] 


THEIR  NATURE  AND  CAUSES 

these  classifications,  but  there  remains 
to  us  a  collection  of  well-established 
data. 

The  situation  is  quite  different  when 
one  considers  the  psychoses  and  psy- 
choneuroses.  When  one  has  thorough- 
ly grasped  the  intervention  of  the  mind 
in  the  genesis  of  psychological  and 
physiological  troubles,  one  perceives 
that  analysis  often  unites  what  one 
wishes  to  separate,  and  one  experiences 
a  growing  difficulty  in  circumscribing 
the  affection  that  one  studies.  Far 
from  defining  itself,  the  morbid  entity 
seems  to  dissolve  in  our  hands. 

Is  it  simply  to  the  insufficiency  of  our 
knowledge  that  one  must  attribute 
these  difficulties?  No.  They  are  due 
to  more  profound  causes.  The  morbid 
entity,  in  the  proper  sense  of  the  word, 
can  only  be  created  in  lesional  diseases, 
when  pathological  anatomy  lets  one  put 
the  finger  upon  the  primitive  alteration, 
[17] 


NERVOUS    STATES 

and  recognize  the  causes,  multiple  per- 
haps, but  univocal.  The  type  of  these 
diseases  is  the  microbic  affection. 
Whatever  may  be  the  results  of  more 
profound  study  of  the  biology  of  the 
microorganisms,  scarlatina  will  remain 
separate  from  measles,  typhoid-fever 
will  not  be  confounded  with  cholera; 
altho  they  have  different  causes — 
traumatic,  microbic,  or  chemical — the 
inflammations  of  the  organs  will  keep 
their  clinical  and  anatomo-pathological 
autonomy. 

But  already  in  the  domain  of  ma- 
terial medicine  the  receptivity  in  regard 
to  pathogenic  agents  varies  according 
to  the  constitution,  according  to  the 
physical  and  even  psychic  nature  of  the 
subjects;  and  so  it  is  difficult  to  state 
the  causes  precisely — to  say  where 
health  ends  and  disease  begins.  Here, 
also,  one  is  often  obliged  to  recognize 
"Natura  non  facit  saltus." 
[18] 


THEIR  NATURE  AND  CAUSES 

As  soon  as  one  enters  upon  the  ter- 
ritory where  the  mental  element  inter- 
venes, one  finds  the  impossibility  of  cir- 
cumscribing true  "morbid  entities." 
According  to  the  primitive  character  of 
the  subject,  his  mentality,  innate  or  ac- 
quired, the  same  etiological  factors, 
physical  or  psychic,  will  produce  differ- 
ent symptoms.  Still,  further,  we  will 
observe  in  the  same  subject  disparate 
symptoms  belonging  to  neighboring 
psychoneuroses,  mixtures  which  in  no 
way  recall  microbic  associations,  or  the 
pure  and  simple  coexistence  of  two  or- 
ganic affections.  P.  Janet  has  pointed 
out  this  fact  very  clearly  from  the  first 
pages  of  his  studies  upon  the  Neuroses 
and  Fixt  Ideas.  Analyzing  with  sub- 
tilty  the  condition  of  his  patient,  M., 
and  indicating  the  analogy  between  the 
"crises  of  dejection"  and  the  "hyster- 
ical symptoms,"  he  adds:  "It  will  per- 
haps be  said  that  we  have  here  an 

[19] 


NERVOUS    STATES 

aboulic  and  psychasthenic  patient  who 
has  hysteria  in  addition.  That  is  not 
our  opinion:  diseases  are  not  entities 
which  enter  into  a  subject  and  range 
themselves  one  beside  the  other;  that 
all  forms  but  a  single  disease.  It  is 
the  same  alienation,  the  same  mental 
perturbation,  which  may  present  it- 
self under  different  but  neighboring 
forms." 

In  certain  studies  in  which  I  am  en- 
gaged I  shall  not  hesitate  to  apply  these 
data  to  the  mental  diseases  properly  so 
called — to  the  confirmed  psychoses. 
They  are  also  bound  together  by  a  nar- 
rower relationship  than  has  hitherto 
been  admitted.  They  arise  from  a  great 
number  of  physical  and  moral  causes, 
acting  upon  subjects  not  only  vaguely 
"predisposed,"  but  abnormal  already  in 
their  primitive  mentality,  in  their  man- 
ner of  reacting  to  the  various  stimuli, 
and  the  same  primitive  mental  defect 

[20] 


THEIR   NATURE   AND   CAUSES 

can  induce  very  different  psychopathic 
forms. 

Is  that  to  say  that  it  is  necessary  to 
suppress  the  appellations  hitherto  em- 
ployed, to  give  up  classification?  Do  I 
propose  to  put  everything  in  the  same 
bag — to  confound  everything — as  the 
authors  who  have  interpreted  me  badly 
seem  to  suggest?  Not  at  all,  and  I  am 
anxious  to  make  myself  clear  upon  this 
point. 


[21] 


NERVOUS    STATES 

II 

PSYCHONEUROSES 

I  HAVE  proposed  to  apply  the  term 
psychoneuroses  to  the  class  of  the 
neuroses  in  order  to  indicate  at  once 
the  influence  of  the  states  of  mind  in 
the  genesis,  the  development,  and  the 
cure  of  these  troubles.  I  in  no  way 
wish  to  resuscitate  the  "nervosisme"  of 
Bouchut  considered  as  a  morbid  entity, 
and  I  have  employed  that  word  only  as 
a  convenient  abbreviation  for  "psy- 
choneuroses." 

In  short,  if  I  have  insisted  upon  the 
bond  which  unites  the  different  psy- 
choneuroses, it  is  in  order  that  the  truth 
may  be  grasped  that — In  the  domain  of 
the  affections  in  which  the  psychic 
factor  intervenes  in  a  preponderating 
manner,  we  can  only  outline  clinical 

[22] 


THEIR   NATURE    AND    CAUSES 

pictures;  passing  from  the  white  of 
ideal  mental  health  to  the  black  of  in- 
sanity, we  can  only  circumscribe  the 
degenerate  by  the  conception  of  group- 
ings of  neighboring  shades.  We  also 
find  observers  contracting  or  enlarging 
these  groups.  Those  who  are  skilful 
in  psychological  analysis  tend  to  efface 
the  boundaries,  to  seize  the  analogies 
which  the  symptoms  present,  to  disclose 
the  common  mentality  which  engenders 
them.  The  pure  clinicians,  preoccupied 
with  their  didactic  task,  wish,  on  the 
other  hand,  to  be  definite,  to  create  au- 
tonomous psychoneuroses.  But  there 
are  not  two  logics — that  of  the  psy- 
chologist and  man  of  science,  and  that 
of  the  clinician  and  practitioner. 

For  every  medical  man  who  thinks, 
there  are  two  preoccupations  which  are 
in  no  way  opposed:  one  is  to  analyze 
the  state  of  his  patients  without  becom- 
ing alarmed  if  his  observations  lead 
[23] 


NERVOUS    STATES 

him  to  regard  the  conditions  from  a 
higher  position,  from  a  point  of  view 
which  renders  the  boundaries  faint; 
that  is  the  theory  which  authorizes  the 
boldest  hypotheses:  the  other  preoccu- 
pation is  of  the  practical  order;  it  con- 
cerns itself  with  the  diagnosis,  prog- 
nosis, and  treatment.  Here  we  can  not 
base  our  judgment  upon  views  of  the 
totality  and  let  our  patient  too  dis- 
tinctly catch  sight  of  the  link  which 
unites  the  simple  neurasthenias  to  the 
psychasthenias  and  these  latter  to  the 
insanities  proper.  That  would  be  not 
only  cruel  but  false,  for  in  presence  of 
a  concrete  case  we  can  almost  always 
marshal  the  symptoms  so  as  to  form  a 
sufficiently  precise  clinical  picture,  tran- 
quilize  the  patient  anxious  to  know  the 
name  of  his  disease,  determine  the 
prognosis  of  the  affection,  and  institute 
the  physical  or  psychic  treatment  which 
is  suitable  in  the  particular  form  of 
[24] 


THEIR   NATURE   AND   CAUSES 

psychoneurosis.  In  theory,  we  analyze 
and  synthetize  turn  about,  without  hav- 
ing in  view  a  special  concrete  case;  in 
practise,  we  no  longer  are  concerned 
with  diseases — we  treat  patients. 

As  often  said,  it  is  necessary  to 
individualize,  and  it  is  with  the  diag- 
nosis that  this  precise  work  begins, 
whose  object  is,  in  fact,  the  restoration 
of  the  patient.  And  without  losing 
sight  of  the  various  hypotheses — the 
views  of  the  totality — we  are  here 
obliged  to  speak  distinctly,  to,  so  to 
speak,  divide  the  questions,  by  using 
the  usual  nomenclature,  even  altho  we 
may  have  good  reasons  to  doubt  its  ex- 
actitude. I  shall  even  go  further  and 
say  that  it  is  necessary  to  define  more 
and  more,  to  classify  the  symptoms, 
discover  those  which  belong  to  such 
and  such  a  clinical  form,  and  establish 
an  always  clearer  nomenclature,  which 
might  be  adopted  by  all  clinicians.  It 
[25] 


NERVOUS    STATES 

matters  little  that  the  proposed  term  be 
very  exact,  expresses  at  once  the  patho- 
geny  of  the  affection,  or  resumes  hap- 
pily the  whole  symptomatology;  it  is 
sufficient  that  it  be  short,  euphonic 
enough  to  enter  into  current  medical 
language,  and  that  it  so  labels,  I  can 
not  too  often  repeat  it,  not  a  morbid 
entity,  but  a  clinical  picture,  recogni- 
zable by  all,  even  tho  we  do  not  all  see 
absolutely  from  the  same  points  the 
limits  which  restrict  it,  and  even  tho 
deeper  study  of  a  case  raises  new 
doubts  and  new  problems. 

Among  the  psychoneuroses,  it  seems 
to  me  that  we  must  now  distinguish : — 

1.  Neurasthenia; 

2.  Psychasthenia; 

3.  Hysteria; 

lastly  encroaching  upon  the  domain  of 
mental  alienation; 

4.  Hypochondria;  and  5.  Melancholia 
in  their  slighter  forms,  which  as  yet  do 

[26] 


THEIR  NATURE  AND  CAUSES 

not  render  the  intervention  of  the  alien- 
ist necessary.  It  is  a  question  of  de- 
gree, and  that  is  why  these  limits  can 
not  be  absolute  and  fixt.  The  alienists 
themselves  continually  reform  their 
classifications,  and  if  their  studies  de- 
fine at  one  point  and  seem  to  create  a 
new  morbid  entity — the  dream  of  every 
classifier — in  another  direction  they 
efface  boundaries  already  traced,  and 
reopen  the  whole  question.  If  there  is 
in  psychiatry  a  clinical  picture  with 
very  distinct  outlines,  it  is  assuredly 
that  of  simple  melancholia.  An  attempt 
has  been  made  to  deny  its  existence  and 
to  include  it  in  circular  insanity  pre- 
senting alternately  melancholia  and 
mania.  There  would  then  no  longer  be 
a  disease  meriting  the  name  of  simple 
mania,  and  yet  what  is  there  more 
typical  than  the  mental  state  of  a  pa- 
tient in  maniacal  delirium?  In  certain 
modern  treatises  of  psychiatry  one 
[27] 


NERVOUS    STATES 

looks  in  vain  for  the  disease  called 
hypochondria;  now  it  is  only  hypo- 
chondriac symptoms  supervening  in  the 
course  of  various  psychopathies  that 
are  spoken  of.  Cat  at  any  is  also  losing 
the  character  of  a  morbid  entity  which 
Kahlbaum  gave  to  it,  and  catatonic 
states  only  are  referred  to,  intermin- 
gling in  certain  subjects  with  the  ordi- 
nary symptoms  of  their  psychopathy. 

For  my  part,  I  have  for  these  various 
reasons  a  certain  repugnance  to  the  use 
of  the  words  neurasthenia,  hysteria, 
etc.,  which  easily  give  rise  to  the  too 
precise  idea  of  the  morbid  entity,  and 
I  prefer  to  distinguish  among  the  psy- 
chopathic states,  which,  beside  the  or- 
ganic affections  of  the  nervous  system, 
form  the  clientele  of  the  modern  neu- 
rologist : — 

1.  The  neurasthenic  states; 

2.  The  psychasthenic  states; 

3.  The  hysterical  states; 

[28] 


THEIR  NATURE  AND  CAUSES 

4.  The  hypochondriac  states; 

5.  The  melancholic  states. 

In  all  these  patients,  under  the  in- 
fluence of  causes  at  once  physical  and 
moral,  the  trouble  may  be  aggravated 
and  take  a  delirious  insane  form.  Con- 
finement is  often  then  necessary,  and 
we  give  place  to  the  alienist.  We  ex- 
pose ourselves  to  his  criticisms,  for  he 
sometimes  smiles  with  pity  on  learning 
of  our  attempts  at  psychotherapy;  he 
even  accuses  us  of  having  aggravated 
the  state  of  the  patient.  He  is  right 
when,  owing  to  want  of  clinical  ex- 
perience, we  do  not  recognize  general 
paralysis  under  the  deceptive  mask  of 
neurasthenia,  or  when  we  neglect  to 
confine  a  proved  melancholic  in  time 
to  protect  him  from  suicide.  But  our 
psychiatrist  is  wrong  when  he  believes 
that  confinement  suffices,  and  that  it  is 
perfectly  useless  to  apply  a  psycholog- 
ical treatment,  a  rational  psychotherapy, 
[29] 


NERVOUS    STATES 

to  these  various  psychopathies.  He 
laughs  best  who  laughs  last. 

Let  us  note  particularly  that  these 
various  psychoneuroses,  these  psycho- 
pathic states,  very  characteristic  with- 
out being  narrowly  limited,  may  arise 
upon  the  basis  of  organic  affections  of 
the  nervous  system,  such  as  epilepsy, 
general  paralysis,  the  encephalopathies, 
the  myelopathies,  the  toxic  neurites, 
and  may  appear  in  imbeciles,  degen- 
erates with  corporal  and  mental  stig- 
mata, and  complicate  acute  or  chronic 
diseases  of  most  of  the  organs. 

Let  us,  finally,  very  specially  insist 
upon  the  morbid  relationships,  the 
frequent  combination  uniting  neuras- 
thenia to  psychasthenia  and  to  hysteria, 
upon  the  almost  constant  intervention 
of  the  hypochondriac  and  melancholic 
states,  and  the  insensible  progress  to 
paranoic  and  delirious  forms.  Not  that 
this  transformation  is  frequent  or  ne- 
[30] 


THEIR  NATURE  AND  CAUSES 

cessitated  by  the  evolution  of  the  dis- 
ease, that  there  is  therefore  great 
danger  of  the  neurasthenic  or  the  psy- 
chasthenic  becoming  insane;  no,  these 
various  conditions  are  sufficiently  typ- 
ical to  be  recognized  and  diagnosed, 
and  for  one  to  be  able  to  establish  a 
probable  prognosis.  One  may  express 
oneself  as  if  one  had  to  do  with  differ- 
ent diseases,  but  one  must  not  forget 
that  we  are  dealing  with  psychopaths, 
and  that  one  can  not  always  stop  one- 
self at  will  upon  the  slippery  path  of  the 
troubles  of  the  mind. 


[31] 


NERVOUS    STATES 


III 

OVERWORK  AND   FATIGUE 
AS  CAUSES 


E£T  us  return  to  our  subject;  that  is 
to  say,  to  the  "neurasthenic  states/' 

It  is,  indeed,  the  most  frequent  dis- 
ease at  the  present  day,  the  most  spoken 
of.  There  is  no  medical  man  who  does 
not  see  his  consulting-room  filled  with 
these  patients,  more  or  less  incapable 
of  living  their  life  normally;  he  often 
has  too  many,  and  if  the  patient,  with 
good  right,  complains  of  the  torment 
which  his  nerves  impose  upon  him,  the 
medical  man  is  sometimes  tempted  to 
say  —  "But  you  do  not  think  of  my 
burden!" 

By  the  fault  of  Beard  himself,  who 
put  the  phobias  and  other  obsessions 
[32] 


THEIR  NATURE  AND  CAUSES 

among  the  symptoms  of  his  "neur- 
asthenia," and  of  the  moderns  who 
have  abused  the  word  to  incorporate 
all  kinds  of  morbid  forms,  neurasthenia 
has  become,  as  has  been  said,  the  "giant 
of  neuropathology." 

Far  from  wishing  to  confuse  and  to 
further  enlarge  this  giant,  I  wish,  on 
the  contrary,  to  diminish  it. 

Reduced  to  its  characteristic  symp- 
toms, neurasthenia  forms  a  clinical 
picture  quite  as  definite  as  hysteria,  and 
more  circumscribed  and  more  stable 
than  the  modern  psychasthenia. 

The  neurasthenic  states  are  charac- 
terized, above  all,  by  subjective  symp- 
toms, among  which  predominate  the 
sensations  of  fatigue,  of  exhaustion, 
and  incapacity  in  the  physical,  intel- 
lectual, and  moral  domain.  One  ob- 
serves in  these  patients  psychic  depres- 
sion, hypochondriac  preoccupations,  and 
a  melancholic  disposition.  Lastly,  by 
[33] 


NERVOUS    STATES 

the  complaints  of  the  patient,  as  well  as 
objective  examination,  we  find  a  series 
of  functional  symptoms:  cephalalgia, 
rachialgia,  insomnia,  gastro-intestinal 
dyspepsia,  palpitation,  and  vasomotor 
disorders,  innumerable  troubles  of  the 
functioning  of  the  sense  organs,  real 
and  not  imaginary  amyosthenia,  etc. 

At  the  commencement,  or  in  the 
forms  which  remain  slight,  the  neu- 
rasthenic resembles  a  fatigued  person, 
and  all  the  authors  have  pointed  out 
among  the  etiological  factors  those 
which,  by  the  physical  or  psychic  path, 
can  lessen  the  force  of  resistance  of  the 
nervous  system :  overwork — physical, 
intellectual,  or  emotional;  infectious 
diseases — influenza,  typhoid-fever,  ma- 
laria, syphilis,  and  tuberculosis;  con- 
stitutional dyscrasias — gout,  diabetes 
and  arterio-sclerosis ;  pregnancy,  lacta- 
tion, senility,  alcoholism,  etc.  Trau- 
matism  has  been  recognized  as  a  cause 
[34] 


THEIR   NATURE    AND    CAUSES 

of  true  neurasthenia  by  the  physical 
and  psychic  shock  which  accompanies  it. 
Reduced  to  these  dimensions,  neu- 
rasthenia might  be  termed  chronic  ac- 
cumulated fatigue.  This  is  why  it  has 
been  said  that  we  are  all  more  or  less 
neurasthenic  at  times  when  we  have 
been  overworked.  This  is  so  true,  that 
the  neurasthenic  state  can  be  provoked, 
so  to  speak,  experimentally  by  fatigue 
in  subjects  otherwise  normal.  Tissie 
expresses  himself  as  follows: — "Vio- 
lent exercise,  pushed  to  extreme  fa- 
tigue, in  highly  trained  men,  healthy 
and  robust,  by  a  bicycle  race,  walking, 
or  any  prolonged  and  rhythmic  muscu- 
lar work,  provokes  experimental  and 
transitory  psychoses.  These  psychoses 
have  the  same  outward  manifestations 
as  the  pathological  psychoses  of  morbid 
subjects,  hysterical,  degenerate,  insane, 
etc.  As,  for  example,  the  ennui  which 
dominates  them  all,  and  which  one  al- 
[35] 


NERVOUS    STATES 

ways  finds  at  a  given  moment  in  the 
gayest  and  best-balanced  subjects." 

Observe  how  near  this  "petite  neu- 
rasthenic" is  to  the  normal  state.  Ennui 
is  so  characteristic  of  the  human  species 
that  Pascal  said,  "Man  would  weary 
even  without  any  cause  for  weariness, 
from  the  condition  of  his  constitution." 
Goethe  exprest  the  same  idea  in  the 
whimsical  fancy — "If  monkeys  could 
suffer  from  ennui  they  would  be  men." 

Fere  2  similarly  points  out  the  mental 
symptoms  of  fatigue,  and  insists  upon 
the  analogies  which  they  present  to 
those  of  neurasthenia. 

"Fatigue,"  he  says,  "often  provokes 
ideas  of  negation,  persecution,  and  dis- 
paragement. Altruistic  sentiments  give 

1  Ph.  Tissie.  "L'entrainement  intensif  a  bi- 
cyclette,"  Revue  scientifique,  Oct.,  1894.  "La  fatigue 
ches  les  debiles  nerveux  et  fatigues,"  ibid.,  Oct., 
1896. 

*  Fere.  "Les  troubles  mentaux  de  la  fatigue," 
Medicine  Moderne,  Nov.,  1898. 

[36] 


THEIR    NATURE    AND   CAUSES 

place  to  egoism,  which  shows  itself  in 
the  most  varied  forms.  The  subject  is 
incapable  of  reacting  against  obsessions 
and  impulses  which  may  become  irre- 
sistible." 

Lagrange  and  Gilbert  Ballet  have 
described  these  temporary  neuras- 
thenias due  to  overwork,  and  appearing 
in  the  "trained"  simply  because  they  do 
not  perceive  their  fatigue  in  time.  Bin- 
swanger  1  points  out  as  possible  conse- 
quences of  mountain-climbing,  not  only 
physical  depression,  but  insomnia,  sen- 
sibility to  sound  and  light,  hallucina- 
tory states,  restlessness  of  the  limbs, 
trembling,  states  of  distress,  irritabil- 
ity, sadness,  tears,  and  jactation. 

Here  we  have,  then,  in  the  opinion 
of  competent  observers,  pure  fatigue 
creating  neurasthenic  states,  and  al- 
ready obsessions  and  impulses  are  seen 

1  Die  Pathologic  und  Therapie  der  Neurasthenic, 
Jena,  1906. 

[37] 


appearing — an  outlined  sketch  of  the 
psychasthenic  states. 

For  my  part  I  would  strictly  confine 
the  term  neurasthenic  state  to  those 
states  of  fatigue  due  to  multiple  pono- 
genic  causes.  I  have  never  employed 
it  in  a  more  extended  sense,  including 
with  it  the  morbid  impulses,  the  various 
phobias,  obsessions,  and  fixt  ideas. 
Even  altho  these  mental  symptoms  were 
accompanied  by  neurasthenia — which 
is  most  usually  the  case — I  have  always 
had  the  impression  that  we  were  con- 
cerned here  with  graver  states,  entail- 
ing a  much  more  serious  prognosis. 

We  shall  see  later  the  intimate  bond 
which  unites  the  neurasthenia  thus 
limited  to  the  psychasthenia  of  Janet, 
but  let  us  keep  for  the  present  to  this 
simple  neurasthenia,  to  the  true  neu- 
rasthenic state.  It  is  easy  to  diagnose, 
since  all  of  us  have  experienced  its 
symptoms,  and  we  have  only  mentally 
[38] 


THEIR  NATURE  AND  CAUSES 

to  multiply  them  tenfold  to  put  our- 
selves in  the  place  of  our  patients;  that 
will  give  us  sympathy  for  them,  and 
perhaps  the  means  of  comforting  and 
curing  them. 

Viewed  thus  from  a  distance,  and 
closing  the  eyes  a  little,  neurasthenia 
appears  as  a  somewhat  benign  disease, 
much  resembling  ordinary  fatigue,  ex- 
aggerated in  predisposed  subjects.  The 
trouble  seems  to  be  physical,  and  one 
comes  quite  naturally  to  treat  it  almost 
entirely  by  rest  when  exhaustion  pre- 
dominates, by  training  and  exercise 
when  one  suspects  a  little  want  of 
initiative  under  this  incapacity ;  re- 
source is  had  to  cures  by  altitude,  baths, 
douches,  and  physical  and  medicinal 
tonics.  One  is  a  little  astonished  when 
one  observes  the  frequent  inefficiency  of 
all  these  means,  the  relapses  which  al- 
most continually  succeed  the  temporary 
improvements,  and  make  of  so  many 

[39] 


NERVOUS    STATES 

neurasthenics  the  too  faithful  residents 
of  the  hydrotherapeutic  establishments. 
One  is  then  obliged  to  differentiate  be- 
tween the  temporary  exhaustion  in  the 
overworked,  and  the  tenacious  inca- 
pacity of  the  neurasthenic.  This  fatigue 
becomes  inexplicable  when  one  has  to 
do — and  that  is  frequently  the  case — 
with  people  who  are  never  overworked 
physically  and  intellectually,  who  have 
rested  for  so  many  years  that  their  idle- 
ness is  a  burden  to  them.  Then  every- 
thing is  explained  by  the  predisposition, 
by  a  native  nervous  weakness.  It  is 
thought  that  harmful  influences  act 
upon  physically  weak  people,  which 
would  have  had  no  effect  upon  strong 
persons. 

But  when  one  looks  closer  at  the 
matter,  one  changes  one's  opinion;  the 
trouble  does  not  appear  so  benign  when 
one  sees  it  coincide  with  mental  symp- 
toms, and  evolve  toward  psychasthenia. 
[40] 


THEIR   NATURE   AND   CAUSES 

All  the  authors  have  insisted  upon 
the  mental  state  of  these  patients,  and 
have  pointed  out  the  psychic  depres- 
sion, the  feebleness  of  attention,  aboulia, 
emotivity,  and  autosuggestibility  in  the 
sense  of  hypochondriac  preoccupations. 
It  is  true  that  in  order  to  maintain  the 
autonomy  of  this  psychoneurosis,  or  of 
this  syndrome — the  name  has  nothing 
to  do  with  it — one  passes  over  these 
capital  symptoms  a  little  rapidly,  and 
specifies  that  there  is  no  perversion  of 
the  judgment;  that  that  remains  intact 
in  spite  of  the  general  depression  of 
the  debilitated  and  exhausted  psychic 
faculties.  It  is  with  difficulty  that  I 
imagine  this  integrity  of  the  judgment 
in  such  a  mental  state. 

In  short,  forgetting  a  little  too 
readily  the  native  predisposition  which 
was  postulated  to  explain  how  these 
subjects  succumb  to  commonplace 
causes,  a  sort  of  synonymity  is  created 
[41] 


NERVOUS    STATES 

between  the  terms  true  neurasthenia 
and  acquired  neurasthenia,  while  the 
new  appellation  psychasthenia  has  to 
designate  the  hereditary  or  constitu- 
tional neurasthenia  of  Charcot  and 
Giles  de  la  Tourette. 

Moreover,  the  same  accidental  causes 
are  attributed  to  the  latter  as  to  true 
neurasthenia;  these  are — I  quote  Pro- 
fessor Raymond — all  those  which  have 
a  debilitating  action:  depressing  emo- 
tions, excesses  of  all  kinds,  intellectual 
overwork  and  cerebral  fatigue,  trauma- 
tisms,  infectious  diseases,  chronic  dis- 
eases, severe  hemorrhages,  etc.;  in  a 
word,  all  the  influences  which  disturb 
the  general  nutrition  and  the  function- 
ing of  the  nervous  system. 

Those  influences  which  in  normal  in- 
dividuals would  produce  the  true  neu- 
rasthenic state — often  benign  and  cur- 
able— induce  the  more  severe  affection, 
the  psychoneurosis  autonomous  with 

[42] 


THEIR   NATURE   AND    CAUSES 

psychasthenia,  when  they  act  upon  ab- 
normal subjects — impressionable,  timid, 
hesitating,  soft,  lacking  initiative,  odd, 
dreamers,  over-scrupulous,  exagger- 
ating the  importance  of  their  small 
faults,  and  at  the  same  time  irritable 
and  changeable  in  humor. 

Well,  I  consider  that  the  true  neu- 
rasthenics have  been  very  badly  ob- 
served. Without  it  being  necessary  to 
declass  them,  one  sees  in  them  a  great 
many  of  these  mental  defects,  and  these 
characteristic  blemishes  are  not  pro- 
duced accidentally  by  overwork,  the  al- 
leged author  of  all  the  mischief:  due  to 
heredity  first  of  all,  and  education  af- 
terward, they  existed  long  before  the 
crisis  of  neurasthenia.  In  them,  as  in 
the  psychasthenic,  "the  mechanism  was 
ready  to  work ;  the  motive  circumstance 
represented  merely  the  fall  of  the  lever 
permitting  the  starting-  of  the  machin- 
ery" (Professor  Raymond). 

[43] 


NERVOUS    STATES 

One  is  apt  to  go  a  little  too  quickly 
in  examining  the  heredity  of  these  true 
neurasthenics.  Most  often,  upon  the 
simple  affirmation  of  those  interested — 
the  patient  or  his  relatives — it  is  de- 
clared that  there  is  no  psychopathic 
heredity,  or  that  it  is  of  little  moment. 
The  opinion  of  the  patient  is  accepted 
at  once,  that  he  was  well  until  the  time 
when  influenza,  overwork,  or  cares 
overcame  him,  and  a  diagnosis  is  made 
of  accidental  acquired  neurasthenia. 
The  opinion  would  be  changed  if  one 
had  observed  the  patient  and  his  family 
before  the  crisis,  and,  in  fact,  one  ar^ 
rives  at  quite  other  views  when  one  ob- 
tains an  intimate  acquaintance  with  the 
physical  and  mental  personality  of  the 
subject,  when  one  comes  to  know  his 
parents,  brothers,  and  sisters. 

One  finds,  then,  that  our  true  neuras- 
thenic belongs  to  a  family  of  psycho- 
paths, in  which  one  often  discovers 

[44] 


THEIR  NATURE  AND  CAUSES 

psychasthenic  states,  hysteria,  epilepsy, 
migraine,  idiots,  imbeciles,  or  insane 
persons,  etc. 

One  apprehends  the  influence  of  edu- 
cation, which  also  creates  psychasthenia 
by  the  false  ideas  and  superstitions 
which  it  develops,  when  it  ought  to 
give  us  a  clear  view  of  things,  and  lead 
us  to  the  mastery  of  ourselves. 

Often,  alas,  one  has  to  withdraw 
from  the  favorable  prognosis  that  one 
has  made  as  the  result  of  a  temporary 
therapeutic  success,  for  some  years  af- 
terward one  finds  the  subject  with  fully 
developed  psychasthenia,  or  affected, 
as  the  result  of  an  emotion,  with  mental 
confusion  of  the  melancholia. 

The  psychiatrist  of  the  University  of 
Geneva,  Professor  Weber,  was  not 
wandering  from  the  truth  when  he  said 
to  one  of  my  pupils:  "Pretty  often  the 
patients  whom  you  have  treated  as  neu- 
rasthenics come  back  to  us  as  psycho- 
paths." 

[45] 


NERVOUS    STATES 

On  the  other  hand,  one  also  observes 
many  cases  in  which  severe  and  in- 
veterate symptoms  of  true  neurasthenia 
disappear  in  the  space  of  a  few  days, 
under  the  influence  of  restorative  con- 
versations, by  the  reading  of  a  psy- 
chotherapeutic  letter,  or  a  medical  work 
explaining  clearly  the  influence  of  men- 
tal representations  in  the  development 
of  this  psychoneurosis. 

Whether  one  is  dealing  with  the  in- 
curable invalids,  who  remain  all  their 
lives  in  this  state  of  true  neurasthenia, 
and  whom  I  have  compared  to  "spirit- 
less horses,"  with  the  less  rebellious 
neurasthenias  which  last  for  some  years, 
or  the  frequent  cases  which  yield  rapidly 
to  a  rational  psychotherapy,  it  is  neces- 
sary always  in  our  thoughts  to  put  in 
the  forefront  the  psychic  symptoms: — 
the  pusillanimity,  the  tendency  to  dis- 
couragement and  sadness,  and  the  ab- 
sence of  self-mastery. 

[46] 


THEIR  NATURE  AND  CAUSES 

Professor  Raymond  1  has  recognized 
this  well,  without  drawing  from  it  all 
the  logical  consequences,  when  he 
writes — "Even  those  arthritic  patients 
who  have  the  mastery  of  themselves, 
who  dominate  their  emotions  instead  of 
being  led  by  them,  in  a  word,  those  who 
have  a  strong  and  firm  brain,  escape 
neurasthenia." 

It  could  not  be  better  exprest,  and 
it  is  precisely  this  weak  brain  which 
constitutes  a  native  and  not  acquired 
psychasthenia,  just  as  with  a  simple  dif- 
ference of  degree  in  the  neurasthenia 
termed  constitutional.  The  ground 
here  is  also  degenerative,  altho  we  do 
not  yet  observe  the  gross  physical  and 
mental  stigmata  of  degeneration,  or 
rather  of  human  imperfection. 

1  F.  Raymond.   Neuroses  et  psychoneuroses.  Legons 
faites  a  la  Salpetriere,  Paris,  Delarue,  1907. 


[47] 


NERVOUS    STATES 


IV 

EDUCATION  OF  THE  MIND 
NECESSARY 

A>  soon  as  one  has  fully  grasped  the 
significance  of  this  primary  men- 
tal  weakness,  one  sees  at  once  all  the 
advantage  to  be  obtained  from  an  edu- 
cation of  the  mind.  One  then  recog- 
nizes that  the  innumerable  physiological 
symptoms  are  secondary,  whether  they 
be  produced  by  pure  mental  representa- 
tions, or  whether  these  latter  come  to 
keep  up  and  aggravate  disorders  due 
to  physical  causes. 

Whether  it  begins  by  a  sensation,  an 
accidental  discomfort  in  regard  to 
which  he  distresses  himself  by  reason 
of  his  pusillanimity,  or  whether,  on  the 
other  hand,  it  commences  by  an  emo- 
tion which  disturbs  the  physiological 
[48] 


THEIR   NATURE   AND   CAUSES 

functions,  the  subject  enters  into  a 
vicious  circle,  or  rather  into  a  spiral. 
The  organic  discomfort  which  he  per- 
ceives induces  a  hypochondriac  preoc- 
cupation, an  emotional  disturbance. 
This  perturbs  the  sleep,  causes  palpita- 
tion, or  provokes  gastro-intestinal  dys- 
pepsia. These  disorders  in  their  turn 
distress  the  apprehensive  patient,  fresh 
emotion  engendering  new  functional 
troubles  or  aggravating  those  which  al- 
ready exist;  it  is  another  opportunity 
for  the  patient  to  take  fright  and  to  ad- 
vance always  further  in  the  fatal  spiral. 
For  want  of  having  sufficiently 
clearly  recognized  the  primitive  psychic 
asthenia,  many  medical  men  lay  too 
much  stress  upon  the  physiological 
symptoms,  and  have  recourse  to  what 
is  called  at  the  present  day  physio- 
therapy— to  material  and  medicinal 
treatments.  These  means  give,  I  know, 
undeniable  successes,  sometimes  by 

[49] 


NERVOUS    STATES 

creating  a  state  of  physical  well-being, 
which  directly  influences  the  mental 
condition,  sometimes  by  awakening  a 
beneficent  suggestion  of  cure. 

The  influences  which  debilitate  the 
organism  contribute  very  distinctly  to 
the  origin  and  development  of  the 
psychic  troubles — they  often  explain  the 
frequent  relapses;  on  the  other  hand, 
improvements  of  the  physical  condition 
lead  also  to  happy  modifications  of  the 
mental  state,  in  neurasthenia  as  in  the 
psychasthenic  states  or  other  psycho- 
pathies. It  must  not  be  forgotten  that 
the  mind,  in  "its  turn,  reacts  upon  the 
body,  and  that  the  emotions  can  create 
conditions  of  real  fatigue  and  disturb 
all  the  organic  functions.  It  is  neces- 
sary to  take  fully  into  account  this 
reciprocal  influence  which  the  physical 
and  the  moral  exercise  upon  each  other. 
These  ideas  are  of  capital  importance  in 
the  history  of  the  psychoses  and  the 
[50] 


THEIR  NATURE  AND  CAUSES 

psychoneuroses ;  I  may  therefore  be 
permitted  to  express  myself  in  a  gen- 
eral manner  upon  these  relations. 

I  shall  say,  first  of  all,  that  between 
the  physical  condition  and  the  mental 
condition  there  is  no  direct  and  neces- 
sary bond,  entailing  a  constant  paral- 
lelism between  the  physical  health  and 
that  of  the  mind.  On  the  one  hand,  we 
see  weak,  feeble,  emaciated  creatures 
suffering  from  debilitating  diseases, 
presenting  no  symptom  of  neurasthenia 
or  psychasthenia ;  these  are  healthy 
minds  in  sick  bodies:  conversely  one 
sees  the  various  disorders  of  the  psy- 
chopathies succeeding  each  other  in 
men  of  herculean  frame,  enjoying  ex- 
cellent physical  health,  and  who  have 
not  been  subjected  to  any  marked  de- 
bilitating influence.  It  is  therefore 
false  to  immediately  conclude  the  men- 
tal integrity  from  the  physical  health, 
and  to  always  seek  in  the  body  the 
[51] 


NERVOUS    STATES 

cause  of  the  psychic  disequilibrium. 
But  if  the  individual  subjected  to  any 
debilitating  causes  has  defects  at  the 
bottom  of  his  mentality,  the  physical 
weakening  leads  to  psychopathic  symp- 
toms, or  causes  them  to  reappear  after 
the  physical  and  moral  rest  of  the 
curative  measures  have  silenced  the 
episodic  manifestations  of  the  psycho- 
neurosis. 

That  is  why  it  is  an  advantage  to 
combat  all  physical  weakness  in  these 
patients,  and  to  place  them  in  the  most 
favorable  dynamogenic  conditions.  But 
that  does  not  mean  to  say  that  this 
treatment  suffices;  it  is  yet  more  im- 
portant to  reform  the  primitive  men- 
tality. 

Our  mental  defects  —  irritability, 
tendency  to  discouragement,  pusillanim- 
ity in  regard  to  illness  and  to  death, 
impressionability,  etc. — exist  in  the  in- 
nate and  acquired  disposition  of  our 
[52] 


THEIR  NATURE  AND  CAUSES 

mind,  due  to  heredity  and  to  education. 
If  the  general  health  is  good,  these 
faults  remain  more  or  less  concealed, 
like  rocks  at  the  bottom  of  the  sea, 
covered  at  high  tide.  Let  some  de- 
bilitating influence  arise — physical,  in- 
tellectual, and,  above  all,  emotional  fa- 
tigue— and  these  defects  are  laid  bare, 
like  the  rocks  at  low  tide. 

Normal  as  we  think  we  are,  we  have 
all  these  psychic  debilities,  and  when  we 
are  fatigued  and  weakened,  we  react  in 
the  sense  of  this  primitive  mentality. 
Fatigue  renders  one  irritable,  another 
sad;  it  awakens  the  spirit  of  contradic- 
tion which  sleeps  in  us,  diminishes  our 
patience  and  our  sentiments  of  altruism, 
causes  hypochondriac  fears  and  anx- 
ieties to  be  born,  altho  the  idea  of  sick- 
ness and  death  found  us  somewhat  in- 
different in  the  state  of  physical  well- 
being.  This  is  why  the  most  healthy 
man  is  susceptible  of  becoming  tempo- 
[53] 


NERVOUS    STATES 

rarily  neurasthenic,  when  debilitating 
factors  act  upon  him  in  an  intense  and 
continuous  manner. 

The  true  neurasthenic  finds  himself, 
to  begin  with,  in  a  condition  of  infe- 
riority; the  rocks  to  which  I  have  com- 
pared the  mental  defects  are  more  su- 
perficial, and  show  their  surface  as 
soon  as  the  tide  begins  to  ebb.  Causes 
which  would  be  insufficient  to  provoke 
a  diseased  state  in  a  better  endowed 
man  induce  immediately  psychopathic 
and  physiological  symptoms.  The 
smallest  fatigue,  the  slightest  emotion, 
annihilate  the  potential  of  the  subject, 
and  lead  to  incapacity,  to  discourage- 
ment, and  even  indeed  to  suicide.  Also 
often  the  smallest  favorable  event,  good 
news,  a  comforting  word,  produce  the 
opposite  effect  with  like  facility,  and 
power  succeeds  incapacity,  and  cou- 
rageous enthusiasm  lack  of  initiative. 
This  is  not  always  a  flash  in  the  pan, 
[54] 


THEIR   NATURE   AND    CAUSES 

as  has  been  suggested;  it  is  often  a 
new  and  positive  ordering.  It  is  due 
to  the  fact  that  these  subjects  are  im- 
pressionable, and  sensitive,  and  capable 
of  reacting  in  both  senses.  Within  cer- 
tain limits  this  mobility  of  impression  is 
a  good  quality.  That  is  what  caused  my 
excellent  friend,  Professor  de  Speyr, 
Professor  of  Psychiatry  at  Berne,  to 
say:  "It  is  only  the  neurasthenic  who 
do  anything  in  this  world."  He  meant 
by  that  that  the  indifference  which  sim- 
ulates equilibrium  is  not  a  good  charac- 
teristic, and  that  one  can  only  do  useful 
work  by  becoming  enthusiastic,  and  al- 
lowing oneself  to  be  imprest. 

Sandras,1  in  1851,  noted  well  this 
variability  of  the  symptoms  which  may 
diminish  or  disappear  by  a  simple  dis- 
traction; he  saw  also  the  "good  neu- 
rasthenia" when  he  said:  "Nothing  is 

1  Sandras.       Trade    pratique    des    maladies    ner- 
zteuses,  Paris,  1851. 

[55] 


NERVOUS    STATES 

more  admirable  than  this  nervous  state 
when  it  is  at  the  service  of  a  good  head 
and  a  good  heart." 

One  can  then  without  danger  be  a 
little  bit  neurasthenic,  if  one  does  not 
go  too  far  into  psychasthenia,  and  if 
one  avoids  "moral  insanity." 

This  psychic  weakness  of  the  neu- 
rasthenic, this  inability  to  resist  outside 
influences,  has  escaped  no  serious  ob- 
server; but  here  one  sees  two  opposite 
tendencies  appear,  that  of  the  clinicians, 
often  without  knowing  it  imbued  with 
a  false  materialism,  and  that  of  the  psy- 
chologists, who  are  careful  not  to  con- 
found soul  and  brain. 

The  former  maintain  the  morbid 
entities,  and  endeavor  to  introduce  the 
precision  of  the  hospital  clinic  into  this 
"psychiatry."  In  a  too  simplistic  con- 
ception of  psychophysical  parallelism  or 
monism  they  carefully  avoid  the  word 
soul,  while  abusing  the  terms  psychism, 
[56] 


THEIR  NATURE  AND  CAUSES 

psychic,  psychopathy,  and  psycho- 
therapy ;  the  Greek  word  is  allowed,  the 
English  word  causes  a  smile.  They 
seek  in  the  brain  the  material  primitive 
deformation  which  engenders  the  psy- 
chic disorder,  and  as  they  can  not  sus- 
pect there  lesions  accessible  to  our 
means  of  investigation,  they  invoke  in- 
toxications due  to  malfunctioning  of 
the  stomach,  the  intestine,  or  the  glan- 
dular organs,  to  hyperacidity  of  the 
blood,  associating  neurasthenia  with 
the  diseases  due  to  impaired  nutrition 
or  rheumatism.  They  have  so  united 
these  two  conceptions  that  they  com- 
monly speak  of  neuro-arthritic  subjects, 
and  that  has  to  explain  everything. 

But  where  have  they  seen  the  true 
gastropaths  or  patients  affected  with 
diarrhea  or  chronic  constipation  who 
were  neurasthenic  by  that  fact  alone? 
Why  does  this  psychoneurosis,  so  easy 
to  recognize,  not  show  itself  oftener 
[57] 


NERVOUS    STATES 

among  all  these  debilitated,  intoxicated 
hospital  patients?  No  doubt  they  are 
not  of  a  lively  gaiety,  for  they  are  suf- 
fering, but  it  is  a  long  way  from  that 
justified  sadness  to  the  depression  and 
incapacity  of  the  least  neurasthenic. 
Are  there  not  a  great  many  gouty  and 
rheumatic  persons,  if  one  may  make  use 
of  that  vague  term,  who  are  in  no  way 
neurasthenic  even  tho  they  are  peevish  ? 
Why  do  they  not  indicate  neurasthenia 
as  the  almost  necessary  consequence  of 
jaundice,  if  it  be  cholemia  that  makes 
all  the  trouble  ?  Why  inversely  do  they 
see  the  neurasthenic  and  psychasthenic 
states  attack  subjects  immune  from  all 
these  constitutional  maladies?  How  is 
it  that  they  do  not  see  the  almost  con- 
stant inefficacy  of  the  therapeutic  meth- 
ods which  aim  only  at  the  elimination 
of  pathogenic  toxines,  and  do  not  ob- 
serve the  influence  of  therapeutic  sug- 
gestion in  the  cases  which  they  benefit, 
[58] 


THEIR   NATURE   AND   CAUSES 

temporarily,  however,  the  condition  of 
these  patients? 

How  is  it  that  so  many  clinicians 
pass  by  these  facts  which  lie  under  their 
nose  without  seeing  them,  and  do  not 
recognize  the  mental  symptoms  of  their 
patients,  their  state  of  mind,  so  easy  to 
discover,  that  one  can  make  the  diag- 
nosis after  a  few  words  of  conversa- 
tion ?  Why  do  they  persist,  except  per- 
haps in  hysteria,  in  always  seeking  for 
somatic  causes?  It  is  because  on  en- 
tering upon  this  psychiatric  ground 
they  get  away  from  the  data  of  ma- 
terial medicine.  No  doubt,  every  psy- 
chological fact  supposes  a  physico- 
chemical  modification  of  the  cerebral 
cell,  but  that  does  not  mean  that  every 
psychic  disorder  has  its  origin  in  a 
primary  alteration  of  the  brain. 

The  idea  which  another  suggests  to 
us  constitutes  a  psychic  stimulus,  of  a 
complexity  quite  different  to  a  phys- 
[59] 


NERVOUS    STATES 

iological  stimulus,  and  will  produce 
quite  different  reactions,  according  to 
the  previous  mentality  of  the  subject; 
that  is  to  say,  according  to  the  sum- 
total  of  conceptions  which  education, 
acting  upon  an  hereditary  basis,  has 
accumulated  in  his  mind. 

Yes,  it  is  the  work  of  our  Wain, 
stimulated  by  means  of  the  sensorial 
organs,  which  produces  thought,  the 
psychic  phenomena.  But  the  essence 
of  the  soul  is  not  known  to  us,  and  it 
is  as  absurd  to  say  "brain"  instead  of 
"soul"  as  to  confound  "electrical  ma- 
chine" and  "electricity";  we  know  the 
latter  as  little  as  the  abstraction  which 
we  name  "soul."  Nothing  is  more  ab- 
stract, let  us  say  metaphysical,  than  the 
conception  of  force  or  potential  which 
is  denned  as  "the  supply  of  force  ac- 
cumulated at  a  mathematical  point." 
The  physicists  who  believe  that  in  their 
definitions  they  remain  upon  the  solid 
[60] 


THEIR   NATURE   AND   CAUSES 

ground  of  the  physical  make  me  smile; 
they  sail  under  full  canvas  in  the  meta- 
physical quite  as  much  as  the  most 
daring  spiritualist. 

To  suppress  a  question  is  not  to  re- 
solve it.  Therefore,  I  object  to  the 
substitution  of  the  word  brain  for  that 
of  soul:  it  is  a  subterfuge.  We  em- 
ploy too  much  the  language  of  the  anat- 
omist and  the  physiologist,  and  not 
enough  that  of  the  psychologist.  What- 
ever be  the  hypothetical  solutions  at 
which  the  thinker  arrives,  whether  he 
regards  thought  as  a  purely  biological 
phenomenon,  or  whether  he  believes  it 
necessary  to  have  recourse  to  dualism, 
we  do  not  know  the  essence  of  that 
thought;  we  express  an  abstraction  by 
a  word. 

But  in  spite  of  this  obscurity  in  re- 
gard to  the  nexus  of  the  soul  and  the 
body,  we  can  always  distinguish  be- 
tween the  somatogenic  or  ideogenic 
[61] 


NERVOUS   STATES 

origin  of  a  psychic  or  physical  symp- 
tom. It  is  in  the  body  that  one  has  to 
seek  the  cause  of  a  delirium  provoked 
by  fever,  by  intoxications,  by  cerebral 
lesions  verified  or  probable;  it  is  con- 
versely in  the  mind  that  it  is  necessary 
to  locate  the  primitive  stimulus  when 
we  obey  suggestions  of  any  kind,  het- 
erosuggestions  or  autosuggestions. 

I  shall  go  further  and  say  that  even 
when  a  physical  cause  throws  our  mind 
into  disorder  it  does  not  react  in  a 
univocal  manner,  and  we  will  always 
discover  the  primitive  mentality  of  the 
individual  in  the  toxic  delirium. 


[62] 


THEIR   NATURE    AND   CAUSES 


V 


THE  LINK   BETWEEN   MIND 
AND  BODY 

IT  is  therefore  necessary  to  distin- 
guish carefully  between  the  physical 
constitution  and  the  mental  constitution, 
between  the  "corpus  sanum"  and  the 
"mens  sana."  There  is  a  link  between 
these  two  healths,  we  are  obliged  to 
admit  it,  in  virtue  of  the  verified  paral- 
lelism of  the  facts  of  consciousness  and 
the  cerebral  work;  but  the  idea  acts 
upon  the  functioning  of  our  organs  at 
the  same  time  that  the  bodily  condition 
reacts  upon  our  thought.  When  one 
regards  psychopaths  as  well  as  the  peo- 
ple called  normal,  it  would  often  be 
more  exact  to  say  that  it  is  the  healthy 
mind  which  makes  the  healthy  body 
than  to  inverse  the  proposition.  What 
creates  the  neurasthenic  is  not  the  ac- 

[63] 


NERVOUS   STATES 

cidental  provocative  agent  which  acts 
upon  so  many  others  without  troubling 
their  functions;  nor  is  it  either  the 
vague  predisposition  admitted  after  the 
event,  by  a  logical  induction — it  is  a 
primitive  weakness,  an  asthenia* 

Is  this  debility  physical  ?  Is  it  neces- 
sary to  seek  its  cause  in  a  constitutional 
pathological  state  of  the  cerebral  cell, 
or  in  alterations  which  it  suffers  later 
by  the  somatic  path?  I  should  be  very 
sorry  if  it  were  so,  for  I  should  then 
no  longer  have  the  courage  to  enter 
upon  the  treatment  of  these  patients. 
To  modify  a  constitutional  cerebral 
state  is  a  very  arduous  task,  and  no  one 

1  In  a  profound  study  of  the  treatment  of  neu- 
rasthenia and  hysteria,  Dr.  Dunin  of  Warsaw  has 
clearly  shown,  and  before  me,  how  commonplace 
are  the  occasional  causes  which  lead  to  neuras- 
thenia. What  characterizes  the  neurasthenic  is 
his  mentality,  which  renders  him  pusillanimous, 
anxious  about  himself,  and  feeble  in  will  (Grund- 
satze  der  Behandlung  der  Neurasthenic  und  Hysteric. 
Berlin,  1902). 

[64] 


THEIR   NATURE   AND    CAUSES 

will  make  me  believe  that  it  is  sufficient 
to  add  to  hygiene  the  pitiful  processes 
of  physiotherapy  in  order  to  obtain 
durable  results.  I  know  of  no  medical 
means  to  restore  such  fragile  cellular 
groups  to  their  original  state. 

I  know  very  well  that  in  these  pa- 
tients one  often  finds  a  condition  of 
weakness  quite  material,  and  alongside 
of  the  mental  symptoms  a  crowd  of 
real  infirmities.  Beard  notes  in  his 
subjects :  A  frail  organization,  the  hair 
fine,  the  skin  delicate,  the  features 
small,  the  bones  slender,  the  muscula- 
ture feeble,  an  evident  physical  feeble- 
ness therefore.  He  adds,  "that  this 
condition  is  often  allied  to  a  superior 
mind,  to  an  active  and  animated  nature, 
and  that  this  constitution  is  more  often 
met  with  in  civilization,  in  the  towns 
than  in  the  country."  He  finds  in  the 
antecedents  of  these  patients  "the  tend- 
ency to  true  diseases  of  the  nervous 
[65] 


NERVOUS    STATES 

system;  in  early  infancy — convulsions, 
irritability,  and  cerebral  affections; 
later,  chorea  and  analogous  affections; 
at  puberty — chlorosis,  headaches,  sper- 
matorrhea,  and  sometimes  epilepsy;  at 
adult  age — migraines,  neuralgias,  nerv- 
ousness and  loss  of  flesh  following 
dyspepsia,  and  in  its  train  constipation, 
insomnia,  functional  or  even  organic 
paralyses,  hypochrondria  and  neuras- 
thenia; in  women — hysteria,  spinal  irri- 
tation, and  a  whole  series  of  nervous 
affections  in  the  course  of  uterine  dis- 
eases; in  old  age — cerebral  softening 
and  organic  paralyses.  He  resumes: 
"A  child  born  nervous  may  have,  during 
lactation,  spasm  of  the  glottis;  in  in- 
fancy, chorea;  at  puberty,  pollutions; 
between  twenty  and  fifty  or  sixty  years, 
dyspepsia  and  neuralgias:  he  may  die 
of  apoplexy  or  softening  of  the  brain." 
How  true  this  picture  is  for  many 
cases,  but  how  desperate;  for,  however 
[66] 


THEIR    NATURE    AND   CAUSES 

much  a  therapeutist  one  may  be,  it  is 
hardly  possible  to  be  sufficiently  naive 
to  think  to  altogether  change  such  a 
personality  in  so  far  as  it  is  physical. 
Yes,  there  are  some  patients  who  cor- 
respond to  this  type,  and  it  is  these 
who,  unfortunately,  often  escape  our 
therapy.  They  would  be  at  once  and 
forever  incurable  if  the  whole  of  their 
unhealthy  state  depended  only  upon 
their  material  structure,  upon  all  these 
more  or  less  indelible  defects.  Happily 
in  that  there  is  a  gross  error,  not  in  the 
observation  of  these  facts — one  might 
infinitely  prolong  the  list  of  these  phys- 
ical defects — but  in  their  interpreta- 
tion. 

First  of  all,  it  must  not  be  forgotten 
that  there  are  many  individuals  who 
have  presented  in  their  life  these  va- 
rious symptoms,  and  who  are  in  no  way 
neurasthenic;  there  are  even  some  of 
them  who  have  numerous  corporal  stig- 
[67] 


NERVOUS    STATES 

mata  of  degeneration — receding  fore- 
head, prognathism,  the  ears  badly  mar- 
gined or  winged,  etc.,  and  who  as  much 
by  their  intelligence  as  by  their  moral 
worth  surpass  the  physically  better  en- 
dowed. 

But,  contrary  to  Beard,  it  is.  before 
all,  necessary  to  classify  the  symptoms, 
not  in  an  anatomical  order,  but  ac- 
cording to  the  determining  factors,  ac- 
cording to  their  rank,  and  to  find  the 
link  which  unites  them  to  each  other. 
The  capital  defect  in  the  true  neuras- 
thenic is  fatigability,  the  tendency  to 
exhaustion;  it  shows  itself  on  the  oc- 
casion of  physical  and  intellectual  work 
as  well  as  in  the  face  of  moral  suffer- 
ing. 

This  fatigue  reveals  itself  not  only  in 
the  subjective  sensation  of  functional 
incapacity,  but  by  a  mass  of  symptoms, 
among  which  I  note: — the  various 
cephalalgias,  rachialgia,  pains  in  the 

[68] 


THEIR    NATURE   AND   CAUSES 

limbs  and  muscular  cramps,  functional 
insufficiencies  of  the  sense  organs,  con- 
ditions of  gastro-intestinal  dyspepsia, 
verifiable  by  objective  examination, 
anomalies  of  the  functioning  of  the  va- 
rious tissues,  betraying  an  actual  lower- 
ing of  the  organic  vitality — all  symp- 
toms which  may  arise  in  the  individual 
termed  normal,  when  temporary  in- 
fluences have  acted  powerfully  or  in  a 
too  continuous  manner. 

On  the  other  hand,  one  finds  a  great 
many  symptoms  which  are  attributable 
to  the  emotivity  of  the  subject,  another 
mental  stigma  of  the  neurasthenic; 
these  are : — variations  in  the  expression 
of  the  eyes,  in  the  dimensions  of  the 
pupils,  in  the  play  of  the  physiognomy, 
tears,  emotional  blushing,  sweating  of 
the  hands  and  feet  produced  by  the 
least  emotion,  palpitations,  insomnia 
fostered  by  preoccupations,  trembling 
and  convulsive  movements,  the  sudden 

[69] 


NERVOUS    STATES 

loss  of  muscular  power  by  emotional 
inhibition,  virile  impotence  from  timid- 
ity, etc. 

When  one  tries  to  apportion  the 
share  of  these  two  factors  letting  loose 
the  functional  symptoms,  fatigue  and 
emotivity,  one  perceives  that  it  is  im- 
possible to  separate  them  exactly  in 
every  case.  Thus  weakness  of  the 
voice,  frequent  at  certain  times  of  the 
day,  may  be  attributed  to  a  real  fatigue, 
or,  on  the  other  hand,  may  be  due  to 
embarrassment,  emotion,  or  autosug- 
gestion. Asthenopia  may  follow  ex- 
cessive work,  and  seem  to  be  due  to  an 
exhaustion,  but  it  shows  itself  so  quick- 
ly, often  before  any  effort,  that  one  is 
obliged  to  think  of  autosuggestions  of 
incapacity,  of  an  anticipated  pono- 
phobia  derived  from  the  pusillanimous 
state  of  mind. 

Sensibility  to  atmospheric  influences, 
heat  and  especially  cold,  often  appears 

[70] 


THEIR  NATURE  AND  CAUSES 

to  be  due  to  a  condition  of  malnutrition, 
to  insufficiency  of  the  peripheral  circu- 
lation; conversely  it  may  show  itself  in 
the  absence  of  any  circulatory  trouble, 
and  disappear  so  quickly  under  the  in- 
fluence of  a  moral  cause,  that  one  is 
obliged  to  introduce  the  psychic  state, 
autosuggestion. 

The  muscular  weakness  may  appear 
real ;  that  is  to  say,  adequate  to  the  ex- 
penditure of  organic  carbon,  when  it  is 
seen  in  a  debilitated  or  actually  over- 
worked subject;  one  recognizes,  on  the 
other  hand,  the  conviction  of  incapacity, 
the  fear  of  fatigue,  when  the  muscles 
are  sufficient  and  there  has  been  no 
work  performed.  The  mental,  auto- 
suggestive  nature  of  this  fatigue  re- 
veals itself  even  by  its  exaggeration, 
the  exhaustion  surpasses  all  limits,  or 
by  what  I  have  called  revealing  contra- 
dictions, the  patient  becoming  suddenly 
capable  of  a  greater  effort  than  that 
[71] 


NERVOUS    STATES 

which  one  demanded  of  him,  or  sus- 
taining under  the  influence  of  its  at- 
traction an  intellectual  fatigue  superior 
to  that  which  he  shunned  to  undertake. 

The  pains  in  the  limbs,  spontaneous 
or  on  the  occasion  of  any  exercise, 
piano-playing,  dressmaking,  etc.,  are 
sometimes  so  intense  that  the  physician 
hesitates  to  speak  of  algogenic  auto- 
suggestions, and  yet  a  few  counsels  of 
a  moral  nature  suffice  to  dissipate  these 
old  and  rebellious  incapacities. 

In  presence  of  those  who  declare 
themselves  incapable  of  an  intellectual 
effort,  one  has  great  difficulty  in  dis- 
tinguishing the  conditions  of  true  in- 
capacity and  imaginary  incapacity,  un- 
til the  patient  himself  is  astonished  at 
having  been  able  to  support  without 
fatigue  a  psychotherapeutic  conversa- 
tion of  two  hours,  altho  his  head  gets 
confused  when  he  attends  a  lecture  of 
one  hour's  duration.  He  observes  this 
[72] 


THEIR   NATURE   AND   CAUSES 

contradiction  himself,  and  explains  it 
by  saying  that  at  the  lecture  he  allows 
himself  to  be  more  easily  overcome  by 
the  conviction  of  incapacity.  And 
henceforth  the  headaches  no  longer  oc- 
cur after  half  an  hour's  work  if  you 
have  made  your  patient  thoroughly  to 
understand  how  the  autosuggestion  en- 
gendered by  pusillanimity  provokes  the 
subjective  and  objective  symptoms  of 
fatigue. 

Asthenopias  which  have  lasted  for 
years  and  resisted  the  treatment  of  the 
oculists  yield  in  a  few  days,  even  in- 
deed after  a  single  consultation,  when 
one  has  been  able  to  demonstrate  to  the 
patient  that  a  healthy  eye  can  not  be 
exhausted  in  a  few  minutes,  and  that 
in  the  fatigue  there  is  more  of  pono- 
phobia  than  of  real  exhaustion. 

The  patients  are  numerous  who  rec- 
ognize that  their  insomnia  is  the  fruit 
of  a  preoccupation,  of  the  fear  of  not 
[73] 


NERVOUS    STATES 

sleeping;  there  are  some  of  them  who 
confess  quite  frankly  that  they  make 
the  autosuggestion  of  insomnia  them- 
selves. 

The  palpitations  of  neurasthenics 
arise  almost  always  from  emotion, 
either  under  the  influence  of  a  definite 
fear,  or  that  vague  fear  which  results 
from  a  permanent  sentiment  of  fragil- 
ity. You  will  easily  discover  the  man 
who  gets  panic-stricken  under  the 
tachycardiac  neurasthenic. 

The  innumerable  patients  who  have 
been  termed  "false  gastropaths"  can  be 
easily  led  back  to  the  regime  of  ordi- 
nary people,  even  when  for  years  they 
have  practised  a  debilitating  regime, 
from  fear  or  by  the  advice  of  doctors, 
and  in  vain.  They  then  lose  the  con- 
stipation of  small  eaters  and  the  muco- 
membranous  colitis  which  is  its  conse- 
quence. 

Unhappy  persons  who  have  created 

[74] 


THEIR   NATURE   AND   CAUSES 

for  themselves  and  for  those  belonging 
to  them  an  existence  of  martyrdom  by 
their  inaptitude  for  any  physical  or  in- 
tellectual work,  and  by  their  want  of 
resistance  to  trouble,  often  return  very 
quickly  to  a  normal  life  when  they  un- 
derstand the  action,  not  dynamogenic, 
but  dynamophanic,  of  courage. 


[75] 


NERVOUS    STATES 


VI 


THE  MIND  THE  BEST  WEAPON 
IN   THE   COMBAT 

THE  physician  who  studies  the 
state  of  mind  of  his  patients  will 
have  no  difficulty  in  recognizing  the 
primary  evil  in  this  psychic  asthenia, 
united  sometimes,  but  not  always,  with 
physical  constitutional  asthenia.  He 
will  consider  pusillanimity  and  want  of 
self-mastery  as  characteristic  of  these 
patients. 

He  will  in  no  way  renounce  the  phys- 
ical means  calculated  to  increase  the 
strength  and  to  dissipate  the  accumu- 
lated fatigue  which  the  neurasthenic 
crisis  represents.  First  of  all,  he  will 
have  recourse  to  rest — that  of  the 

[76] 


THEIR    NATURE   AND    CAUSES 

simple  sojourn  in  the  country  if  the 
corporeal  condition  is  still  satisfactory; 
to  rest  in  bed,  if  the  exhaustion  de- 
mands it.  He  will  lead  the  patient  back 
to  the  ordinary  diet  if  he  be  only  slight- 
ly dyspeptic;  he  will  subject  him  to  a 
cure  by  superalimentation,  which  is  not 
a  cramming,  if  it  be  a  case  for  inducing 
a  rapid  increase  of  the  strength  and 
weight,  and  of  dissipating,  at  the  same 
time,  phobias  on  the  subject  of  alimen- 
tation. He  may  add  to  these  two  prin- 
cipal measures  the  less  active  processes 
of  massage,  regulated  gymnastics,  or  a 
discreet  hydrotherapy. 

For  my  part,  I  have  given  up  the 
greater  part  of  these  auxiliaries.  I  no 
longer  require  isolation,  unless  to  elim- 
inate the  absolutely  undesirable  in- 
fluences of  relations;  I  only  have  re- 
course to  rest  in  bed  in  conditions  of 
extreme  malnutrition  and  fatigue,  when 
there  are  persistent  cephalalgias  and 
[77] 


rachialgias;  I  no  longer  prescribe  su- 
per alimentation  except  when  the  emaci- 
ation is  considerable.  Massage  is  still 
practised  in  my  clinic  as  a  slight  auxil- 
iary, which  I  readily  put  aside  if  it  be 
badly  borne,  or  to  spare  a  patient  not 
very  well  off  this  small  supernumerary 
expense ;  that  is  the  value  I  attach  to  it. 
I  have  abandoned  all  hydrotherapeutic 
measures,  while  recognizing  that  a 
good  hydrotherapeutic  establishment,  in 
a  fine  climatic  situation,  might  be  a 
choice  sanatorium  for  a  physician  de- 
voted to  psychotherapy.  He  would, 
however,  run  a  great  danger,  I  have 
many  times  observed  it,  of  creating  in 
his  patients  too  great  a  faith  in  these 
physical  means,  and  of  causing  them  to 
forget  the  task  of  greater  importance, 
self -education. 

As  the  medical  experience  grows,  the 
gift  of  persuasion  increases.     It  acts 
not   only  by  those   quite  personal   in- 
[78] 


THEIR   NATURE   AND   CAUSES 

fluences  which  result  from  the  bond  of 
confidence  and  sympathy  which  unite 
the  patient  and  medical  man — and 
which  are  wrongly  termed  suggestive 
— but  by  an  ever  closer  dialectic,  by  an 
inculcation  of  sentimental  logic. 

The  patient  is  not  cured  when  by 
physical  or  even  psychic  treatment  we 
have  caused  the  disappearance  of  the 
disorders  which  produced  the  fatigue. 

It  is  necessary  to  reveal  the  causes  of 
this  exhaustion,  and  to  prevent  their 
action  in  the  future.  There  are  only 
four  causes  of  fatigue: — 

Physical  work,  intellectual  work, 
abuse  of  pleasures,  and  the  emotions. 
It  is  these  last  which  constitute  the 
richest  source  of  fatigue;  it  is  this 
whose  debit  we  must  reduce. 

There  are  some  neurasthenics  who 

have  burned  the  candle  at  both  ends; 

they  have  combined  severe  sports  with 

intellectual  work,  practised  onanism  or 

[79] 


NERVOUS    STATES 

other  excesses;  they  have,  besides,  cul- 
tivated their  impressionability  like 
artists.  Many  others  have  been  so 
feeble  all  their  life  that  it  would  be 
ridiculous  to  speak  of  overstrain,  either 
by  work  or  by  excesses  of  which  they 
would  be  incapable.  They  have  had  some 
real  cares  and  many  others  imaginary, 
and  have  not  been  able  to  overcome 
their  emotivity.  They  confess  them- 
selves that  they  make  an  emotion  out 
of  anything  and  out  of  nothing.  By 
physical  treatment  and  simple  encour- 
agement one  pretty  easily  overcomes 
the  exhaustion  induced  by  these  various 
influences;  one  helps  the  patient  to  pay 
the  debts  he  has  incurred.  If  he  be 
sagacious,  he  will  be  able  to  draw  some 
benefit  from  this  experience,  and  dis- 
cover himself,  without  the  aid  of  the 
physician,  the  causes  of  his  crisis,  and 
avoid  it  in  the  future.  But  these  are 
the  minority  among  the  patients;  the 

[80] 


THEIR  NATURE  AND  CAUSES 

greater  number  fall  again  under  the 
influence  of  new  debilitating  physical 
and,  above  all,  moral  causes.  They  will 
return  to  their  habitual  medical  man, 
the  gastro-therapeutist,  who  knows  their 
stomach  so  well  and  the  virtue  of  re- 
gimes, the  past-master  of  the  douche 
who  directs  the  spray  as  a  virtuoso,  the 
electro-therapeutist  handling  with  pre- 
cision the  multiple  manettes  of  his  ma- 
chines, not  forgetting  the  gynecologist 
who  will  always  find  something  to 
scrape,  to  cauterize,  or  a  uterus  to  re- 
place. Often,  too,  the  discouraged  pa- 
tient will  seek  a  cure  in  some  other 
land;  one  must  console  oneself,  since 
no  one  is  a  prophet  in  his  own  country. 
It  will  always  be  so  if  the  trouble  be 
seen  only  in  the  symptoms  of  the  neu- 
rasthenic crisis,  and  one  thinks  of  elim- 
inating only  the  provoking  agents,  the 
accidental  causes.  The  situation  is  the 
same  as  in  hysteria,  which  has  caused 
[81] 


NERVOUS    STATES 

it  to  be  said  that  the  symptoms  of  that 
psychoneurosis  are  cured  but  not  the 
disease,  which  is  the  hysterical  men- 
tality. 

It  is  the  neurasthenic  mentality  that 
must  be  attacked.  Its  principal  charac- 
ter is  pusillanimity.  In  virtue  of  hered- 
itary predispositions  and  educative  in- 
fluences, the  subjects  susceptible  of  fall- 
ing into  the  neurasthenic  state  through 
the  provoking  agents  have  not  that  ro- 
bust good  sense,  that  balance,  which 
permits  of  adaptation  to  life. 

They  bring  into  their  activity  inde- 
cision and  scruples  derived  always  from 
fear. 

In  face  of  the  least  discomfort  they 
take  fright,  and  believe  themselves  af- 
fected with  a  grave  malady;  they  in- 
crease their  pusillanimity  by  reading 
medical  works,  by  consulting  pessimis- 
tic medical  men,  often  hypochondriac 
themselves,  who  are  of  opinion  that  one 
[82] 


THEIR   NATURE   AND   CAUSES 

must  always  be  cautious  and  apply  to 
every  trifle  the  powerful  weapons  of 
modern  therapy.  There  are  clinics 
where  indeed  it  seems  as  tho  they  had 
set  themselves  the  task  of  cultivating 
this  nosophobic  neurasthenia.  In  all 
these  patients  you  will  observe  the  diffi- 
culty of  adapting  themselves  to  life  as 
it  is  given  to  us,  of  supporting  its 
vicissitudes  with  patience  and  courage; 
they  have  not  yet  carried  out  sufficient- 
ly the  education  of  their  moral  self. 

It  is  this  insufficiency  of  the  intelli- 
gence, particularly  in  the  ethical  do- 
main, that  one  has  to  recognize  the 
primary  trouble,  not  a  simple  predispo- 
sition, but  an  actual  defect,  ascertain- 
able  as  soon  as  one  knows  one's  patient. 
The  patients  may  be  very  gifted  in 
other  ways,  be  very  intelligent,  have 
many  estimable  qualities  of  heart  and 
mind;  they  lack  that  good  sort  of  stoi- 
cism necessary  in  the  struggle  of  life. 
[83] 


NERVOUS    STATES 

The  conception  of  this  primitive  de- 
fect has  made  me  say,  "As  the  tree 
grows,  so  it  falls."  There  you  see  the 
fundamental  psychopathy  whose  neu- 
rasthenic crisis  is  only  an  episodic  man- 
ifestation, provoked  by  debilitating  in- 
fluences. 

The  situation  is  therefore  the  same 
as  in  psychasthenia,  to  which  I  must 
devote  a  few  pages. 

Altho  I  am  obliged  already  to  recog- 
nize this  psychasthenia  in  all  my  neu- 
rasthenics, and  find  it  again  in  many 
psychoses,  and  altho  doubts  may  be 
raised  as  to  the  opportuneness  of  this 
new  appellation,  I  am  glad  that  Janet 
has  proposed  it.  In  his  admirable 
analyses  he  has  avoided  the  dogma  of 
the  "morbid  entity,"  and  demonstrated 
the  bond  which  unites  the  psychoneu- 
roses  to  each  other  and  to  the  psy- 
choses. A  fear  comes  to  me,  however, 
that,  still  more  than  "neurasthenia," 

[84] 


THEIR   NATURE   AND   CAUSES 

psychasthenia  may  become  the  giant  of 
neuropathology  and  of  psychiatry.  But 
let  us  await  the  future  reconstructions. 

For  the  present  the  psychasthenia  of 
Janet  forms  a  clinical  picture  sufficient- 
ly well  drawn  and  better  named  than 
that  of  Beard,  in  the  sense  that  it  de- 
notes by  a  word  the  primitive  mental 
defect  and  causes  it  to  be  looked  for  in 
the  mentality  and  not  in  the  nerves. 

But  it  is  not  at  all  in  the  work  of 
classification,  in  the  creation  of  an  au- 
tonomous psychoneurosis,  that  I  see  the 
astonishing  originality  of  the  French 
psychologist.  His  work  has  quite  a 
different  import,  as  much  theoretical  as 
practical.  He  has  put  into  the  group 
of  the  psychoneuroses,  which  can  not 
only  be  studied,  but  improved  and 
cured,  psychopathic  states  which  one 
readily  sent  to  the  alienist  or  treated 
only  with  reluctance,  haunted  as  one 
was  by  the  idea  of  their  incurability. 

[85] 


NERVOUS    STATES 

One  rather  left  them  lying  in  the  large 
drawer  of  degeneration,  opened  too 
widely  by  Morel,  and  divided  into  small 
compartments  by  Magnan.  The  word 
degenerate  was  not  exactly  made  to 
give  us  courage. 

No  doubt  a  new  appellation  does  not 
suffice  to  improve  the  prognosis  of  a 
disease,  and  our  neurasthenics  and  psy- 
chasthenics  remain  indeed  mental  de- 
generates and  will  so  remain  in  spite 
of  all  the  psychological  analyses.  But 
the  fine  studies  of  Janet  have  enabled 
us  to  better  grasp  the  insensible  grada- 
tion which  unites  normal  fear  to  phobia 
or  to  mania  of  touch  ("delire  du 
toucher"),  common  indecision  to  mania 
of  doubt  ("folie  du  doute"),  and  which 
turns  the  conscientious  into  sufferers 
from  unhealthy  scruples,  etc. 

In  the  fine  work  published  in  col- 
laboration with  Professor  Raymond,  he 
describes  successively,  at  the  same  time 
[86] 


THEIR   NATURE   AND   CAUSES 

uniting  them,  certain  clinical  pictures — 
the  neurasthenic  states  and  the  aboulic.1 
In  aboulia  there  appear  sentiments  of 
incompletion.  Then  the  term  neuras- 
thenia disappears  from  his  descriptions, 
in  proportion  as  the  symptoms  become 
more  mental  and  more  severe.  We  are 
there  fully  into  psychasthenia,  which  is 
cousin  to  epilepsy  and  migraine.  We 
learn  to  know  the  agitations  and  diffuse 
anguish,  of  which  it  has  been  so  often 
proposed  to  make  new  morbid  entities. 
Then  come  the  phobias,  creating  some- 
times algias  and  sometimes  phobias  of 
the  functions,  among  others,  that  of 
alimentation,  so  frequent  in  the  true 
neurasthenic,  the  phobia  of  objects,  that 
of  situations,  in  particular  agoraphobia, 
common  also  in  the  "petits  neuras- 
theniques." 

1  Professors  F.  Raymond  and  Pierre  Janet.  Les 
obsessions  et  la  psychasthenie,  Paris,  Felix  Alcan, 
1903. 

[87] 


NERVOUS    STATES 

We  proceed  in  this  matter  afterward 
to  the  tics  and  to  innumerable  manias, 
from  those  which  are  compatible  with 
the  normal  state  to  those  which  touch 
upon  paranoia.  In  the  second  part  we 
find  described  the  obsessional  ideas; 
they  comprize  the  hypochondriac  ideas, 
nosomania  and  thanato phobia,  the  ob- 
sessions of  shame,  associated  with 
modesty  and  timidity,  the  amorous  ob- 
sessions, often  associated  with  the  need 
of  natural  direction  in  persons  of  feeble 
mind.  Moral  insanity  appears  in  the 
criminal  obsessions  in  the  form  of  im- 
pulses or  remorse,  in  the  sacrilegious 
obsessions,  whose  origin  is  in  super- 
stitious ideas.  The  last  chapter  is  de- 
voted to  distinctly  insane  conditions: — 
mental  confusion  with  stupor,  hallucina- 
tions, catatonic  attitudes,  or  system- 
atized insanities.  Am  I  not  right  in 
saying  that  already  psychasthenia  has 
taken  gigantic  proportions  under  the 

[88] 


THEIR   NATURE   AND   CAUSES 

pen  of  Janet  ?  It  is  not  convenient  for 
amateurs  of  classifications,  but  this  de- 
scription is  true.  At  the  base  of  all 
these  states,  from  the  most  ordinary 
neurasthenia,  termed  acquired  because 
one  sees  only  the  accidental  crisis,  to 
the  most  characteristic  insanity,  there 
is  a  weakness  of  judgment,  a  psychas- 
thenia;  that  is  to  say,  a  difficulty  in 
effecting  that  mental  synthesis  which 
alone  permits  of  living  with  sensations 
adequate  to  the  reality,  in  everything 
and  everywhere  being  to  the  point. 

Janet  has  not  neglected  to  point  out 
the  possible  somatic  origin  of  such 
states,  to  recognize  that  they  may  be 
cerebral.  But  he  has  insisted  upon 
the  influence  of  ideas,  of  mental  repre- 
sentations created  through  personal 
experiences  or  suggested  by  others, 
undergoing  deformations  in  these  sub- 
jects of  weak  mind  and  causing,  espe- 
cially by  way  of  the  emotions,  the 

[89] 


NERVOUS    STATES 

physical  and  psychic  symptoms  of  fa- 
tigue pushed  to  exhaustion. 

He  has  seen  clearly  the  suggestibility 
of  these  patients,  their  need  of  direction 
which  ties  them  to  the  hypnotizer  or  to 
the  psychotherapeutist ;  he  does  not 
overlook  the  possible  dangers  of  purely 
suggestive  methods. 

In  a  chapter  entitled  Education  of  the 
Mind,  he  has  pointed  out  all  the  benefit 
that  may  be  obtained  from  a  rational 
psychotherapy,  from  persuasion  by 
word  of  mouth.  I  have  been  the  better 
able  to  recognize  the  good  foundation 
of  these  views  as  I  have  applied  them 
during  thirty  years  for  the  treatment 
of  all  my  neurasthenics,  to  the  hys- 
terical, and  to  all  those  psychasthenics 
whom  formerly  I  approached  more 
timidly,  imbued  as  I  was  by  the  idea  of 
incurable  degeneration.  The  attentive 
and  repeated  reading  of  the  masterly 
works  of  Janet  gives  me  a  new  courage, 
[90] 


THEIR   NATURE   AND    CAUSES 

by  demonstrating  the  success  which  one 
may  obtain  in  cases  which  appear  des- 
perate. I  have  for  a  long  time  seen  re- 
sults in  old  psychaSthenias  which  have 
surpassed  my  expectation. 

There  is,  however,  one  point  in  which 
I  differ  from  Janet,  and  I  noted  some 
years  ago,  at  the  end  of  the  fine  chap- 
ter upon  "The  Education  of  the  Mind," 
this  remark:  "This  education,  how- 
ever interesting  it  may  be,  is  still  too 
purely  intellectual;  it  must  be  more 
moral,  moralizing,  and  must  have  for 
its  aim  the  giving  back  to  the  patient 
the  mastery  of  himself/' 

No  doubt  the  culture  of  the  intel- 
lectual faculties  by  graduated  work, 
literary  essays,  pianoforte  exercises,  or 
teaching  may  have  a  happy  influence, 
if  one  takes  care  to  avoid  fatigue;  but 
one  runs  against  a  difficulty.  It  would 
then  be  necessary  to  go  over  again  the 
entire  education  of  the  subject,  from 

[91] 


NERVOUS    STATES 

the  infant  school  to  the  highest  class ;  it 
would  be  necessary  to  devote  oneself 
for  some  years  to  a  single  patient,  to 
be  his  preceptor  and  form  his  mind. 

The  ideas  of  which  the  patient  has 
need  are,  in  my  opinion,  of  quite 
another  order  than  those  which  give 
instruction — school  crams  us  with  those 
without  forming  our  judgment — they 
are  those  which  create  moral  intelli- 
gence. It  is  easy  to  show  the  most  il- 
literate patient  the  disastrous  influence 
of  fear,  the  harmfulness  of  discourage- 
ment, the  ugliness  of  egoism,  to  make 
him  feel  the  necessity,  for  all  of  us,  of 
adapting  ourselves  to  life.  It  is  upon 
these  moral  ideas  that  it  is  necessary 
to  fix  his  vacillating  attention,  to  de- 
velop in  him  the  faculty  of  mental 
synthesis.  The  task  is,  in  short,  the 
same  as  in  the  education  of  normal 
people.  The  intellectual  work  to  which 
we  have  devoted  ourselves  from  school 

[92] 


THEIR   NATURE   AND   CAUSES 

up  to  the  university  has  not  given  us, 
alas!  that  healthy  ethical  judgment 
which  leads  to  the  mastery  of  self;  one 
finds  it  often  in  persons  without  educa- 
tion; they  have  that  robust  good  sense 
which  is  worth  more  than  the  erudition 
acquired  at  school  or  from  books. 

Like  Janet,  I  recognize  in  the  educa- 
tion of  the  mind  the  most  powerful 
weapon  that  we  have  in  combatting  the 
various  psychoneuroses,  but  from  the 
commencement  of  my  efforts  I  have 
aimed  in  the  direction  of  an  ethical 
logic,  a  sentimental  dialectic;  that  is 
why  I  wrote  "The  Psychoneuroses  and 
their  Moral  Treatment." 

There  is  there  a  differentiation  of  ex- 
treme importance,  for  this  education  in 
the  ethical  domain  is  more  easy  to  ap- 
ply, appeals  to  the  least  cultivated  per- 
sons, and  gives  results  more  prompt 
and,  above  all,  more  durable,  while 
adapting  the  subjects  to  social  life. 

[93] 


NERVOUS    STATES 

I  do  not  enter  here  upon  a  more  ex- 
tended study  of  the  states  named  psy- 
chasthenic;  that  would  be  going  beyond 
my  subject,  and  it  could  not  be  better 
done  than  in  the  works  of  Janet,  which 
every  medical  man  ought  to  read  and 
reread.  One  finds  there  that  delicacy 
of  psychological  analysis  and  that  clear- 
ness which  characterize  French  writers 
so  often,  at  least  those  who  manage  to 
avoid  a  certain  dogmatism  also  inherent 
in  our  Latin  nature. 

I  am  anxious  also  to  clearly  separate 
the  more  benign  states,  which  have 
been  designated  by  the  term  neuras- 
thenia, from  those  grave  forms  in 
which  the  psychopathic  condition  ap- 
pears in  the  forefront. 


[94] 


THEIR   NATURE    AND   CAUSES 

VII 

CONSTANT  AUTOSUGGESTIONS 
AS  CAUSES  AND  REMEDIES 

TO  recapitulate: — 
The  neurasthenic  states  consti- 
tute a  very  characteristic  clinical  pic- 
ture, a  psychoneurosis  as  circumscribed 
as  a  state  in  which  the  mentality  of  the 
subject  intervenes  can  be. 

Considered  in  the  state  of  crisis,  the 
disease  presents  symptoms  which  are 
those  of  fatigue,  of  exhaustion,  creating 
incapacity  in  the  physical,  intellectual, 
and  moral  domain.  To  that  is  added 
an  infinitude  of  painful  sensations,  dis- 
turbances of  the  physiological  functions 
depending  upon  fatigue,  emotion,  or 
both  at  the  same  time,  the  emotion  en- 
gendering the  fatigue,  and  the  latter 
originating  the  emotion. 

These  crises  of  indeterminate  dura- 
[95] 


NERVOUS    STATES 

tion  have,  as  accidental  causes,  all  the 
physical  and  moral  agents  which  can 
exercise  a  debilitating  influence  upon 
the  body  as  well  as  upon  the  mind. 
These  causes  are  absolutely  the  same 
as  those  which  in  other  subjects  create 
the  psychasthenic  states  and  the  psy- 
choses properly  so  called. 

Exact  and  prolonged  observation 
enables  one  to  affirm  the  continual  in- 
tervention of  autosuggestions  in  the 
origin,  the  development,  and  the  cure  of 
the  crisis.  The  symptoms  of  these  pa- 
tients are  not  imaginary,  but  the  atten- 
tion that  they  give  to  them,  the  hypo- 
chondriac ideas  which  they  create  in 
their  subject,  augment  the  suffering 
and  precipitate  them  into  that  "spiral" 
in  which  the  organic  symptom  succeeds 
the  emotion  and  vice  versa. 

During  the  crisis  and  out  of  it,  it  is 
generally  easy  to  discover  in  these  sub- 
jects mental  defects  innate  or  acquired 
[96] 


THEIR   NATURE   AND   CAUSES 

from  the  earliest  years  of  existence,  and 
which  show  themselves  in  pusillanimity, 
emotivity,  aboulia,  indecision,  etc.,  all 
symptoms  which  denote  a  weakness  of 
the  mental  synthesis,  particularly  in  the 
most  delicate  operations,  those  which 
concern  our  moral  life. 

In  the  period  of  crisis,  the  treatment 
must  aim  at  overcoming  the  state  of 
exhaustion  by  the  aid  of  rest,  more  or 
less  complete,  and  by  all  the  measures 
calculated  to  restore  the  vital  energy; 
it  is  important  among  these  last  not  to 
forget  moral  influence. 

But  in  the  course  of  this  treatment, 
as  well  as  in  the  periods  of  well-being, 
it  is  very  important  to  combat  the  pri- 
mary mental  states,  which  have  allowed 
causes,  most  often  commonplace,  to 
provoke  the  state  of  neurasthenic  crisis. 
It  is  here  that  the  education  of  the  mind 
comes  in,  moral  orthopedy  by  means  of 
loyal  persuasion.  It  alone  permits  of 
[97] 


NERVOUS   STATES 

the  diminution  of  the  primitive  psychas- 
thcnia  and  the  avoidance  of  the  relapses 
which  the  return  of  the  accidental 
causes  almost  necessarily  entails. 

Limited  as  a  clinical  picture,  neuras- 
thenia confines  itself  to  the  normal 
state,  for  it  is  proved  that  exaggerated 
fatigue  may  induce  neurasthenic  states 
in  the  best-balanced  individual. 

In  the  graver  forms,  the  mental  de- 
fects are  accentuated  and  neurasthenia 
passes  into  psychasthenia,  and  from 
that  to  the  insanities. 

If  it  be  impossible  to  mark  precise 
limits  in  this  downward  progress,  one 
may  distinguish  different  morbid  forms, 
name  them  according  to  the  predomi- 
nant symptoms,  and  base  upon  these 
observations  the  diagnosis,  prognosis, 
and  treatment  of  a  concrete  case. 

The  nomenclature  may  be  yet  fre- 
quently changed,  uniting  these  clinical 
pictures  or  establishing,  on  the  other 
[98] 


THEIR   NATURE   AND   CAUSES 

hand,  new  subdivisions.  These  classi- 
fications, necessary  in  practise,  will  not 
suppress  two  certain  facts:  (ist)  the 
narrow  relationship  which  unites  the 
psychoneuroses  to  each  other,  and  these 
to  the  psychoses;  (2nd)  the  importance 
of  the  mentality  of  the  subject  as  the 
primary  cause  of  the  symptoms  which 
the  variable  and  contingent  provoking 
agents  produce. 

To  resume: 

I  reserve  the  term  "neurasthenic 
state"  for  the  patients  who  present, 
above  all,  the  symptoms  of  fatigue,  ex- 
haustion, and  incapacity;  a  delicate 
analysis  alone  allows  one  to  establish 
in  what  measure  this  inability  is  phys- 
ical or  psychic.  There  is  already  some 
psychasthenia  in  these  patients;  there 
is  already  some  degeneration;  they  are 
not  of  the  strong. 

The  appellation  "psychasthenia"  is 
applicable  to  the  patients  in  whom  pre- 

[99] 


NERVOUS    STATES 

dominate  the  phobic  obsessions,  the  tics, 
or  the  manias,  etc.  Here  the  psycho- 
pathic state  is  evident;  the  mental  syn- 
thesis is  particularly  defective. 

The  "hysterical  states"  are  charac- 
terized by  an  exaggerated  auto  sug- 
gestibility, which  has  enabled  it  to  be 
said  that  these  phenomena  can  be 
created  and  dissipated  by  suggestive  or 
persuasive  processes.  This  is  not  at 
all  a  certain  criterion,  since  the  same 
means  can  succeed  in  the  other  psycho- 
neuroses,  but  it  is  evident  that  imagina- 
tion plays  a  predominant  part  in  hys- 
teria. There  is  there  also  a  weakness 
of  the  mental  synthesis,  betraying  itself 
by  a  tendency  to  submit  to  the  yoke  of 
the  imagination. 

I  come  finally  to  the  "hypochondriac 
states,"  the  "melancholic  states."  They 
have  in  common  a  foundation  of  sad- 
ness, of  despair,  but  the  preoccupations 
are  different;  the  hypochondriac  pities 
[100] 


THEIR   NATURE   AND   CAUSES 

himself  over  his  state  of  health,  while 
the  melancholic  regards  exterior  cir- 
cumstances with  sadness  or  criticizes 
his  conduct  in  a  self-accusing  frame  of 
mind. 

Under  these  very  different  forms  of 
"psychoneuroses"  one  always  recog- 
nizes a  primitive  mental  defect,  a  psy- 
chasthenia.  In  all  these  patients  there 
is  a  fundamental  inferiority;  call  it  de- 
generation or  imperfection,  that  is  not 
of  great  importance.  It  is  sufficient  to 
know  that  therein  lies  the  primary 
trouble,  and  that  the  form  of  the  psy- 
choneurosis  will  depend  upon  the  men- 
tality peculiar  to  the  subject  and  to  the 
accidental  circumstances  which  provoke 
the  conditions.  Let  us  not  forget  that 
all  these  mental  disorders,  these  emo- 
tions, provoke  fatigue  and  thus  create 
"neurasthenic"  symptoms  which  mingle 
with  those  of  the  primitive  psycho- 
neurosis. 


THIS  BOOK  IS  DUE  ON  THE  LAST  DATE 
STAMPED  BELOW. 


Series  9482 


c«./ry 


ii 


